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AND  SURGEONS   •  LOS  ANGELES,  CALIFORNIA 


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For  Reference 


NOT  TO  BE  TAKEN  FROM  THIS  ROOM 


Digitized  by  the  Internet  Archive 

in  2007  with  funding  from 

IVIicrosoft  Corporation 


http://www.archive.org/details/dietotherapy02fitciala 


DIETOTHERAPY 


DIETOTHERAPY 


NUTRITION    AND 
DIET     IN    HEALTH 


BY 

WILLIAM  EDWARD   FITCH,  M.D. 

MAJOR   MED.    RES.    CORPS,    U.    S.    A. 

FOHMERLT    LECTURER    ON    SURGERY.    FORDHAM    UNIVERSITY    SCHOOL    OF    MEDI- 
CINE;     ASSISTANT     ATTENDING     GYNECOLOGIST     PRESBYTERIAN     DISPEN- 
SARY;     ATTENDING     PHYSICIAN     TO     THE     VANDERBILT     CLINIC, 
COLLEGE    PHYS.    &    SI  RGS.,    NEW   YORK   CITY 


AND 

FORTY    CONTRIBUTORS 


VOLUME    II 


PUBLISHED  WITH  THE  PERMISSION  OF  THE 
SURGEON  GENERAL  OF  THE  ARMY 


D.    APPLETON    AND    COMPANY 
NEW     YORK  LONDON 

1918 


n 7  J JOO 


ME  40O  ■ 

Copyright,  1918,  by 
D.  APPLETON   AND  COMPANY 


Printed  in  the  United  States  of  America 


CONTRIBUTORS  TO  VOLUME  II 

A.  L.  BENEDICT,  A.M.,  M.D.,  F.A.C.P. 
Capt.  Med.  Res.  Corps,  U.  S.  A.;   Consulting  Gastro-Enterologist,  Buflfalo 

Hospital,  Buffalo,  N.  Y. 


WILLIAM  E.  FITCH,  M.D. 
Major  Med.  Res.  Corps,  U.S.A.;  Editor  Pediatrics,  New  York  City 


H.  S.  GRINDLEY,  B.S.,  Sc.D. 

Professor  of  Animal  Nutrition,  College  of  Agriculture,  University  of 

Illinois,  Urbana,  111. 


WINFIELD  S.  HALL,  B.S.,  M.S.,  M.D.,  Ph.D. 
Professor  of  Physiology,  Northwestern  University  Medical  School;  Lec- 
turer on  Dietetics,  Mercy  and  Wesley  Hospitals,  Chicago 


H.  LYONS  HUNT,  M.D.,  L.R.C.P.  (Edin.) 

Capt.  Med.  Res.  Corps,  U.S.A.;  Prof,  of  Medicine 

University  Medical  School,  New  York  City 


GEORGE  N.  KREIDER,  A.M.,  M.D.,  F.A.C.S. 
Captain  Med.  Res.  Corps,  U.  S.  Army 


H.  EDWIN  LEWIS,  M.D. 
New  York  City 


A.  BRUCE  MACALLUM,  A.B.,  M.D. 

Lecturer  Biological  Chemistry;  Sen.  Fel.  in  Medical  Research,  University 

of  Toronto,  Toronto,  Ont. 


E.  E.  SMITH,  Ph.D.,  M.D. 

Formerly  Professor  of  Physiology  and  Biological  Chemistry,  Fordham 

University  School  of  Medicine,  New  York  City 


1U)    0    "    '^  0. 


CONTENTS 


VOLUME  II 

CHAPTER  I 

FOOD  PRESERVATION 
H.  S.  Grindley,  B.S.,  Sc.D. 

FAQB 

Food  Preservation 1 

Drying 2 

Smoking ' 2 

Salting 3 

Refrigeration 3 

Canning 6 

Treatment  with  Chemical  Agents 7 

CHAPTER  II 

PRESERVATION  OF  FOODS  BY  DEHYDRATION 

H.  Edwin  Lewis,  M.D. 

Value  of  Dehydration 9 

Application  of  Dehydration  to  Special  Foods 12 

Desiccation  of  Milk 12 

Dehydration  of  Casein 17 

Dried  Eggs 17 

Preservation  of  Meat  by  Dehvdration 18 

Dried  Fish " 20 

Dried  P>uits 20 

Dehydrated  Vegetables 32 

Success  of  Dehydration 46 

Economic  Advantages 46 

CHAPTER  III 

SCIENTIFIC  COOKERY 
H.  S.  Grindlbt,  B.S.,  Sc.D. 

History  of  Cooking 49 

Principles  of  Scientific  Cooking 51 

Varieties  of  Cookery 54 

Meat 55 

Fish 66 

Vegetable  Foods 67 

Food  Concentration 70 

CHAPTER  IV 

HYGIENE  OF  EATING 

Role  of  the  Senses  in  the  Pleasure  of  Eating 75 

Effect  of  the  Manner  of  Eating  on  Digestion 78 

Drinking  of  Water  with  Meals 88 

vii 


I 


viii  CONTENTS 

7AOB 

Personal  Idiosyncrasies 89 

Order  and  Frequency  of  Meals 90 

Sleep  and  Digestion 93 

Occujiation  and  Digestion 94 

Variety  and  Diet 94 

Relation  of  Medication  to  Meals 96 

CHAPTER  V 

VARIOUS  FACTORS  BEARING  ON  DIET,  DIGESTION  AND  ASSIMI- 
LATION 

A.  L.  Benedict,  A.M.,  M.D.,  F.A.C.P. 

Transmutability  and  Reservation  ct  Foods 99 

Waste  and  Digestibility  of  Foodstuffs 103 

Substitutes  for  Food 108 

Starvation  and  Inanition 109 

Fasting.    ••    •.  • 112 

Perversion  of  Appetite 119 


• CHAPTER  VI 

OVERFEEDING  AND  UNDERFEEDING 

Superalimentation 127 

Overfeeding 128 

Overeating 129 

Effects  of  Overeating 135 

Metabolism  of  Overfeeding 138 

Convalescents 141 

Underfeeding 145 

Malificent  Sequences  of  Underfeeding 148 

Metabolism  of  Underfeeding 153 

Pathology  of  Metabolism  of  Starvation 158 

Conclusions 163 

CHAPTER  VII 

PROTEIN  AND  NUTRITION 

Nature  of  Protein .  167 

Metabolism  of  Protein 169 

Effect  of  Protein  Diet  on  Health  and  Endurance 169 

Standard  for  Protein  Requirement  in  Dietary 180 

High  Versus  Low  Protein  Diet 185 

Protein  Structure  and  Properties 198 

Chemical  Formation  of  Protein  Fractions 198 

Physical  Properties  of  Proteins 201 

Theories  of  Protein  Metabolism 203 

CHAPTER  VIII 

THE  SIGNIFICANCE  OF  LIPOIDS  AND  VITAMINES  IN  ANIMAL 

METABOLISM 

A.  Bruce  Macallum,  A.B.,  M.D. 

Lipoids 219 

Nitrogenous  Importance  of  Lipoids 219 

Lipoids  in  Metabolism 220 

Bio-electric  Potentiality  of  Lipoids 221 


CONTENTS  ix 

PAQB 

Vitamines 221 

Nature  of  Vitamines 221 

Physiological  and  Pharmacological  Properties  of  Vitamines 222 

Destructive  Action  of  Heat  on  Vitamines 222 

Role  of  Vitamines  in  Metabolism    . 224 

Vitamines  in  Foodstuffs 226 

Phosphorous  Content  of  Foods  as  Index  to  Percentage  of  Vitamines 233 


CHAPTER  IX 
THE  CALORIC  METHOD  OF  FEEDING 
WiNFiELD  S.  Hall,  B.S.,  M.S.,  Ph.D.,  M.D. 

Food  as  a  Source  of  Heat  and  Growth 243 

Calculation  of  Fuel  Values  of  Food 257 

Factors  Governing  the  Amount  of  Food  Required 265 

Regulations  of  Body  Temperature 274 

CHAPTER  X 
GENERAL  NUTRITION  AND  MINERAL  METABOLISM 

General  Consideration 285 

Metabolism 286 

Anabolism  and  Catabolism 286 

Metabolism  Experiments 288 

Facts  Which  Affect  Metabolism 295 

CHAPTER  XI 
SCIENTIFIC  FEEDING  OF  NITROGEN  FOODS 

Nitrogen  in  Diet 321 

Protein  Metabolism 327 

Urea 327 

Ammonia 329 

Creatinin 329 

Uric  Acid      329 

Purin  Bodies 329 

Fat  Free  Diet 338 

Carbohydrate  Free  Diet 338 

Cellulose  Free  Diet 339 

Importance  of  Function  of  Mineral  Elements 341 

Mineral  Metabolism 341 

Electrolytic  Properties  of  Salts 343 

Salt  Free  Diet 345 

Low  and  High  Calcium  Diets 349 

CHAPTER  XII 

DIET  IN  HEALTH 

WiNFiELD  S.  Hall,  B.S.,  M.S.,  Ph.D.,  M.D. 

General  Principles 361 

Amount  of  Food  Required 362 

Composition  of  Meals 366 

Various  Influences  of  Diet 368 


X  CONTENTS 

PAQB 

Diet  Studies  of  Various  Clas^5es  of  People 374 

Use  of  Alcohol  in  the  Diet 385 

Diet  in  Tropical  Countries 386 

General  Considerations 386 

Foodstuffs 389 

Alcohol  and  Beverages 401 


CHAPTER  XIII 

DIET  IN   CRITICAL   PHYSIOLOGICAL   PERIODS 

Diet  in  Childhood 409 

Early  Childhood 410 

Diet  for  School  Children 414 

Diet  During  Puberty 418 

Diet  in  Sedentary  Occupations 421 

Diet  During  Menstruation 425 

Diet  During  Pregnancy 425 

Diet  During  the  Puerperium 428 

Diet  During  Lactation      429 

Diet  During  the  Menopause 432 

Diet  During  Old  Age 433 


CHAPTER  XIV 

HYGIENE  OF  THE  INTESTINES 
William  P.  Cunningham,  A.M.,  M.D. 

General  Considerations 455 

Chronic  Intestinal  Stasis 458 

Diseases  Due  to  Chronic  Intestinal  Stasis 460 

Considerations  of  Diet  in  Chronic  Intestinal  Stasis 464 

Hygiene  of  the  Intestinal  Canal 469 


CHAPTER  XV 

PHYSIOLOGICAL  REQUIREMENTS  OF  INFANT  FEEDING  IN  HEALTH 
William  C.  Hollopeter,  A.M.,  M.D.,  LL.D. 

Brea.«t  Feeding 471 

Diet  During  Lactation 481 

Unsuccessful  Nursing 484 

Lack  of  Uniformity  in  Breast  Milk 487 

Deficiency  in  Breast  Milk 487 

Artificial  Feeding 489 

Cow's  Milk 489 

Condensed  Milk 499 

Butter  Milk 500 

Peptonized  Milk 501 

Sterilized  Milk 502 

Pasteurized  Milk 503 

Proprietary  Foods 504 

Rules  Governing  Home  Modification 506 

CUnical  Application  of  Artificial  Feeding 509 

Intervals 511 

Percentages 511 

Fats 511 

Sugars 512 

Proteins 514 

Summary  of  Rules 515 


CONTENTS  xi 

CHAPTER  XVI 
SPECIAL  DIETS 
H.  Lyons  Hunt,  M.D.,  L.R.C.S.  and  P.  (Edinburgh),  L.F.P,  and  S.  (Glasgow) 

PAQB 

Vegetable  Diet 520 

Meat  Diet 532 

Fruit  Diet 540 

Tufnell  and  Bellingham  Diets 547 

Weir  Mitchell  Diet 549 

Training  Diet 552 

Reducing  Diet 559 

Diet  for  Professional  Singers  and  Lecturers 560 

The  Dry  Cure 581 

The  Yolk  Cure 563 

Milk  Cures 684 

CHAPTER  XVII 
PREPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

General  Considerations 577 

Recipes  for  the  Preparation  of  Various  Beverages  and  Foods 578 

CHAPTER  XVIII 
ARMY  AND  NAVY  RATIONS 
George  N.  Kkeider,  A.M.,  M.D.,  F.A.C.S. 

United  States  Army  Rations 663 

Rations  for  Boys'  Military  Camps 684 

Rations  of  Foreign  Armies 697 

Diet  in  Prison  Camps 718 

Conclusions  Regarding  the  Composition  and  Food  Value  of  the  Military  Ration  .    .    .  722 

Navy  Rations 724 

CHAPTER  XIX 
FOOD  ECONOMICS  IN  WAR 

Food  Situation  in  Germany 740 

Food  Situation  in  Great  Britain 747 

Use  of  Certain  Foodstuffs  in  War 759 

Alcohol  in  War  Economics 766 

Food  Situation  in  the  United  States 768 

Index 775 


LIST  OF  ILLUSTRATIONS 
VOLUME  II 

riGURE  PAOB 

1.— The  Vegetables  at  the  Right,  when  Dried,  AVill  Have  Only  the  Bulk  of  the 

Small  Pile  at  the  Left 38 

2. — The  Bucket  and  Milk  Bottles  Contain  the  Water  Extracted  from  this  Box 

of  Vegetables 38 

3. — This  Barrel  of  Dehydrated  Vegetables  Represents  Thirty  Barrels  of  Green 

Vegetables    39 

4. — Diagram  of  the  Benedict  "Universal"  or  "Unit"  Apparatus  for  Measuring 

Absorption  of  Oxygen  and  Output  of  Carbon  Dioxid 247 

5.— Calorimeter 289 

6. — Case  X.    Inflammatory,  Superimposed  upon  Evolutionary  Stasis 456 

7.— E.  B.,  Female,  30,  Single 457 

8. — J.  S.     Chronic  Intestinal  Stasis,  with  Very  Broad  Band  Angulating  Duo- 

deno-Jejunal  Junction  458 

9. — C.   0.     Chronic  Intestinal   Stasis,  with  Marked  Duodeno-Jejunal  Kink, 

Causing  Distention  of  Duodenum 459 

10.— Case  V   462 

11. —  (A)  Band  in  which  Stump  of  Tube  and  Ovary  is  Caught 465 

12. — Component  Parts  of  a  Day's  Ration  of  the  United  States  Soldier,  which 

Represents  a  Food  or  Fuel  Value  of  4,199  Calories 682 

13. — Comparative  Fuel  Value  of  the  Food  Rations  of  the  Soldiers  of  the  Lead- 
ing Armies  of  the  World 700 


DIETOTHERAPY 

VOLUME   II 

NUTRITION  AND  DIET  IN  HEALTH 
CHArTER    I 

FOOD    PRESERVATION 
H.  S.  Grindley,  B.S.,  Sc.D. 


Methods  of  Food  Preservation:  Drying;  Smoking;  Salting;  Freezing; 
Refrigeration;  Sterilization;  Exclusion  of  Air — Canning;  Treatment 
with  Antiseptic  Agents. 


METHODS   OF   FOOD   PRESERVATION 

The  different  methods  of  food  preservation  have  of  late  years  received 
much  attention,  for  it  is  very  largely  due  to  the  different  processes  of 
preserving  food  that  it  is  possible  to  maintain  large  armies  and  navies  in 
action  and  to  permit  of  the  aggregation  of  men  in  communities  away 
from  all  immediate  sources  of  food  supply.  It  was  originally  thought  that 
mere  contact  with  the  air  was  the  prime  cause  of  the  decomposition  of 
food,  but  experiments  have  proven  that  the  great  number  of  germs  con- 
tained in  even  comparatively  pure  atmospheres  are  the  real  agents  of 
putrefaction,  rather  than  the  air  itself.  The  basis  of  all  food  preserva- 
tion depends  upon  the  principle  of  preventing  microorganisms  present  in 
the  atmosphere  from  coming  into  contact  with  food  to  contaminate  it. 
Since  gerros  of  putrefaction  require  a  certain  amount  of  moisture  and 
heat  for  their  growth,  such  foods  as  contain  little  water,  and  that  are  not 
kept  too  warm,  are  not  so  likely  to  undergo  decomposition ;  on  the  other 
hand,  foods  containing  much  water  undergo  fermentation  very  rapidly. 

1 


2  FOOD  preseryatio:n^ 

Yeo(l)    has  suggested  the  following  classification  of  the  methods  for 
preserving  food  products : 


(a)   Drying 

(e)  Refrigeration 

(b)   Smoking 

(/)   Sterilization 

(c)   Salting 

(g)   Exclusion  of  air — canning 

(d)   Freezing 

(h)   Treatment  with  antiseptic 

chemical  agents 

Drjdng. — Drying  is  the  primitive  method  of  preserving  food.  Of 
course,  in  this  process  a  large  proportion  of  water  is  extracted.  Pemmi- 
can  (see  page  19)  is  a  form  of  meat  preserved  by  this  method.  At  pres- 
ent this  form  of  preserving  food  is  limited  mainly  to  fruits  and  vegetables, 
although,  in  some  sections  of  the  great  West  where  excessively  dry  and 
clear  atmospheres  are  found,  meat  may  be  hung  in  the  open  anywhere 
and  be  preserved  by  this  method.  Biltong,  or  dried  beef,  sometimes  called 
"jerked  beef,"  is  kept  by  cutting  it  into  thin  slices  and  drying  it  in  the 
sun  for  several  days.  Familiar  instances  of  preservation  of  fruits  by  this 
method  are  found  in  raisins,  figs,  dates,  prunes,  dried  apples  and  peaches, 
used  also  for  some  vegetables  such  as  lima  beans,  okra,  corn,  etc.  Desic- 
cated meats  and  vegetables,  used  largely  for  making  soups,  have  the  ad- 
vantage of  being  easily  transported  and  at  the  same  time  of  producing 
nutritious  food.     {See  Volume  II,  Chapter  II,  Dehydration.) 

Smoking. — Smoking  is  the  preservation  of  meat  or  fish  by  means  of 
volatilized  creosote  and  other  substances  developed  from  wood  smoke, 
which  have  an  antiseptic  action.  This  process  of  preserving  meat  is  prin- 
cipally applied  to  beef,  tongue,  ham  and  bacon.  The  meat,  on  being 
slaughtered,  is  first  put  down  in  salt  for  several  days ;  it  is  then  taken  up 
and  hung  in  a  chamber  or  confined  "smokehouse,"  and  a  saturated  wood 
fire  is  started.  This  fire  is  usually  made  of  green  wood  and  scraps  of 
leather  thrown  on  the  top  to  add  to  the  smoke. 

The  creosote  rising  from  the  wood  during  combustion  closes  the  pores 
of  the  meat  to  some  extent,  thereby  excluding  air-containing  bacteria. 
Juniper  berries  and  fragrant  woods  are  sometimes  put  into  the  fire  to  give 
additional  flavor.  In  North  Carolina  and  Virginia,  the  famous  "Smith- 
field  hams"  and  bacons  are  cured  by  being  smoked  as  above  for  a  time  and 
then  taken  down  and  the  fleshy  part  of  the  meat  rubbed  over  with  sugar, 
pepper  and  other  condiments.  Then  saltpeter,  which  acts  as  an  antiseptic, 
is  rubbed  well  into  the  flesh,  and  the  meat  is  laid  on  a  bench  for  a  few 
days  and  afterwards  hung  and  smoked  again.  Later  it  is  washed  and 
dried,  and  again  exposed  to  the  fumes  of  the  "smokehouse."     The  outer 


METHODS    OF   POOD    PRESERVATION  3 

surface  of  meat,  such  as  ham  or  bacon,  preserved  by  smoking,  becomes  con- 
siderably drier  and  tougher  than  the  interior,  but  the  latter  is  not  made 
especially  tough  by  the  smoking  if  it  was  originally  tender.  Well-smoked 
bacon  sliced  thin  and  thoroughly  cooked  is  a  very  digestible  form  of  fatty 
food.  The  digestibility  of  hams  is  also  enhanced  by  the  smoking  process. 
In  some  instances  the  process  of  smoking  is  applied  largely  to  the  preser- 
vation of  fish,  and  their  digestibility  and  flavor  are  not  impaired  by 
smoking. 

Salting. — The  salting  of  food  as  an,  agency  of  preservation  is  a 
method  that  has  been  practiced  for  many  centuries.  In  this  way,  meat 
and  fish  are  easily  preserved.  Salted  meat  usually  becomes  pale  from  the 
action  of  the  salt  upon  the  hemoglobin  contained  in  the  blood  vessels  of 
the  muscle  fiber.  The  addition  of  a  little  salpeter  prevents  the  meat  from 
becoming  pale  by  preserving  the  original  reddish  color  of  salted  meat. 

Freezing. — Freezing  is  a  method  of  preserving  food  which  necessitates 
immediate  cooking  after  thawing,  to  prevent  decomposition.  Excepting 
milk  and  cream,  foods  are  not  easily  eaten  in  an  actual  frozen  state,  ex- 
cept by  the  northern  Eskimos,  who  prefer  their  meat  in  that  form.  Meat 
and  fish  may  be  kept  for  considerable  periods  of  time  frozen  in  blocks  of 
ice  without  losing  much  in  flavor,  but  vegetables  are  not  as  good  when 
cooked  after  being  frozen.  Meat  which  has  been  frozen  is  much  better 
cooked  by  roasting  than  boiling,  unless  it  has  been  imperfectly  thawed, 
in  which  case  the  central  portion  may  remain  frozen  after  the  external 
layers  have  begun  to  cook,  and  when  very  large  cuts  are  cooked  by  roast- 
ing, the  inside,  on  being  cut  into,  may  be  found  almost  raw.  Frozen  meat 
loses  about  10  per  cent  of  its  nutritive  value  in  cooking. 

Refrigeration — The  preservation  of  meat  by  refrigeration  or  cold 
storage  has  in  the  past  few  years  practically  revolutionized  the  meat  trade. 
This  method  of  preserving  meat  has  enabled  cargoes  to  be  brought  from 
distant  countries  through  equatorial  regions  not  much  the  worse  for  the 
voyage.  Slaughtering  and  refrigeration  go  on  all  the  year  round  at  the 
great  slaughtering  houses  in  this  country,  and  the  tables  of  both  rich  and 
poor  in  the  large  cities  are  constantly  supplied  with  beef,  mutton,  lamb 
and  chicken.  From  the  earliest  time  the  subjection  of  meat  to  extreme  cold 
has  been  practiced  in  order  to  enhance  jts  keeping  qualities.  Bacterial 
growth  is  inhibited  to  a  greater  or  less  extent  by  refrigeration,  which  con- 
sists (a)  in  actually  freezing  the  meat,  in  which  condition  it  may  be  kept 
without  decomposition  almost  indefinitely  until  finally  thawed  for  use,  or 
(h)  by  keeping  the  meat  at  or  near  the  temperature  of  freezing  without 


4  FOOD    PRESERVATION 

actually  congealing  it,  as  is  done  by  the  use  of  the  ordinary  methods  of  re- 
frigeration. The  second  method,  while  much  less  efficacious  than  the  lirst, 
serves  to  prevent  much  decomposition  for  a  considerable  time,  and  is  pre- 
ferred for  beef,  mutton  and  pork.  Lower  temperatures  are  employed  with 
poultry  and  game.  There  are  many  processes  of  refrigeration  in  use :  the 
direct  expansion,  indirect  expansion  by  circulation  of  cooled  air,  etc. 

THE  EFFECT  OF  PROLONGED  COLD  STORAGE.—  Dr.  Carl  von  Baer 
reported  to  the  Royal  Society  of  London  the  discovery  in  Arctic  Siberia 
of  the  body  of  a  frozen  mammoth,  the  meat  of  which  was  still  preserved. 
As  this  animal  had  been  extinct  since  the  days  of  prehistoric  man,  it  af- 
forded an  illustration  of  the  marvelous  preservative  power  of  intense  cold. 
In  1861  the  entire  bodies  of  three  Swiss  guides,  who  forty  years  before 
had  been  buried  by  an  avalanche  over  the  Glacier  de  Boissons,  were  found 
in  a  state  of  excellent  preservation.  With  these  examples  of  the  influence 
of  cold,  it  is  little  wonder  that  meat  may  be  preserved  for  a  few  months 
on  ice  and  yet  be  quite  fit  to  eat. 

These  two  instances,  however,  are  hardly  in  harmony  with  the  follow- 
ing experiences.  Wiley (2)  records  his  experience  of  examining  a  quar- 
ter of  beef  which  had  been  kept  frozen  in  a  warehouse  for  more  than  eleven 
years.  This  meat  was  found  to  be  wholly  inedible.  It  had  an  unpleas- 
ant and  a  decidedly  mummy-like  odor,  was  light  in  fiber  and  color,  having 
evidently  lost  a  large  part  of  its  weight  and  was  of  a  character  wholly 
unsuitable  for  consumption.  On  one  occasion,  the  author  had  an  oppor- 
tunity of  inspecting  a  large  quarter  of  beef  which  was  furnished  by  a 
western  packing  house  to  the  United  States  Army  for  food,  and  they 
claimed  that  it  had  been  in  cold  storage  for  more  than  twelve  months,  and 
that  it  left  the  storage  in  a  wholesome  condition,  having  been  inspected 
and  passed  by  a  representative  of  the  Government.  It  was  taken  from  the 
refrigerating  cars  still  cold  and  delivered  to  the  commissary  department 
and  was  found  to  be  putrid,  with  foul  odors  emanating  from  it.  It  was 
soft  and  of  such  a  character  as  to  be  wholly  unfit  and  unsuitable  for  con- 
sumption. 

These  facts  appear  to  show  that  in  the  first  instance  eleven  years  is 
too  long  a  time  to  keep  meat  frozen ;  in  fact,  it  is  scarcely  worth  while, 
from  a  practical  point  of  view,  to  discuss  so  long  a  limit.  In  the  other 
instance,  the  facts  point  out  thai  a  shorter  period  of  time  was  conducive 
of  no  better  results.  Only  the  necessary  time  for  the  preparation  and 
transportation  of  the  meat  is  to  be  considered,  and  the  sanitary  laws  of 
the  nation,  state  and  municipality  should  undoubtedly  regulate  the  time 
of  cold  storage  and  see  that  all  packages  of  meat  exposed  for  sale  are 


METHODS    OF    FOOD    PKESEKVATION  5 

plainly  tagged  as  to  the  date  of  the  slaughter,  iu  order  that  the  consumer 
may  know  what  he  is  really  purchasing. 

A  great  variety  of  food  materials  are  now  kept  for  indefinite  periods 
of  time  in  cold  storage — that  is  to  say,  they  are  stored  in  chambers  cooled 
by  air  which  passes  over  pipes  conveying  cold  brine,  carbonic  anhydrid 
or  ammonia  gas.  The  circulation  of  such  air,  by  keeping  the  substance  at 
a  temperature  below  that  necessary  for  the  development  of  putrefactive 
germs,  is  a  sufficient  protection  against  the  processes  of  putrefaction.  Ex- 
perience has  shown  that  the  best  temperature  for  the  preservation  of  ma- 
terials by  cold  storage  is  as  follow^s: 

REQUISITE  COLD  STORAGE  TEMPERATURES  FOR  THE  PRESERVA- 
TION  OF   CERTAIN   ANIMAL   FOODS 

Brined  meat   35  to  40°  F.  Lard  34  to  35°  F. 

Fresh  beef 37  to  39°  F.  Fish    25  to  28°  F. 

Mutton   32  to  36°  F.  Oysters   38  to  42°  F. 

Pork    30  to  33°  F.  Poultry   (frozen)    5  to  10°  F. 

Veal   32  to  36°  F.  Poultry  (cold  storage) 28  to  30°  F. 

Ham    30  to  35°  F.  Fresh  fruit  33  to  40°  F. 

Vegetables   33  to  40°  F. 

After  all  that  has  been  said  in  favor  of  cold  storage  of  meats,  the  fact 
remains  that  meat  which  has  been  in  cold  storage  for  any  length  of  time 
is  not  as  wholesome  and  tasty  as  absolutely  fresh  meat.  It  is  the  opinion 
of  the  author  that  much  of  the  intestinal  disturbance  results  from  the  end 
products  of  protein  digestion,  which  are  to  some  extent  due  to  the  inges- 
tion of  cold  storage  meats.  The  germs  of  putrefaction  attack  meat  very 
soon  after  the  animal  heat  leaves  the  carcass,  and  no  matter  how  it  is  pre- 
served or  what  methods  are  resorted  to  for  its  preservation,  putrefaction 
to  a  greater  or  less  degree  goes  on  until  the  meat  is  cooked. 

It  is  practically  impossible  to  secure  on  the  New  York  markets  an  ab- 
solutely fresh  fowl,  either  duck,  chicken  or  turkey ;  they  have  all  been  in 
cold  storage  for  a  greater  or  lesser  period  of  time,  and  no  matter  what 
price  is  exacted  for  these  fowls,  when  cooked,  the  flesh  next  to  the  bone 
will  have  an  unsavory  odor  and  a  far  from  inviting  or  palatable  taste. 
Even  the  'Tcoshei*"  killed  fowls,  after  a  journey  of  several  hundreds  of 
miles  without  proper  air,  food  and  water,  are  sick,  and  such  fowls  are 
unfit  for  slaughter  unless  turned  into  an  open  lot  and  fed  wholesome 
food  for  a  few  days.  This  of  course  is  not  done.  The  only  people  who 
enjoy  absolutely  fresh  fowls  and  meat  are  people  living  in  rural  districts 
who  can  always  secure  fresh  foods.     Cold  storage  eggs  are  advertised  and 


6  FOOD    PEESEKVATION 

sold  as  "eggs  fresh  from  the  farm,"  whereas  they  may  have  been  in  cold 
storage  anywhere  from  a  few  months  to  a  few  years,  and  instead  of  having 
that  fresh  egg  flavor,  they  will  offer  to  the  olfactory  nerves  an  odor  some- 
what similar  to  that  of  a  rancid  oil. 

Sterilization. — Sterilization,  by  the  application  of  heat  in  sterilizing 
containers,  renders  meat  or  other  foods  germ  free.  Practically  all  thor- 
oughly cooked  food  is,  for  the  time  being,  "sterilized,"  and  it  is  a  well- 
known  fact  that  overdone  meat  keeps  longer  than  underdone  meat,  since 
the  outer  layers  are  firmly  coagulated  and  dried  by  the  heat  of  boiling  or 
roasting  which  forms  an  almost  impervious  envelope,  hermetically  sealing 
it  from  the  air.  The  products  of  decomposition  in  meat  include  albu- 
minoses,  leukomain,  ptomain,  hydrogen,  carbon  dioxid  and  marsh  gas. 

Exclusion  of  Air. — This  is  the  preservation  of  food  by  a  process  of 
canning,  the  principles  of  which  inchide  the  destruction  of  the  organism 
which  produces  putrefactive  changes,  and  afterwards,  the  hermetical  seal- 
ing of  the  container  to  prevent  the  access  of  more  bacteria.  If  the  destruc- 
tion of  the  microorganisms  is  not  complete,  the  bacteria  will  still  produce 
changes  in  the  meat  or  vegetables,  and  the  gases  accumulate  in  the  tin.  If 
the  pressure  is  great  enough,  the  tin  becomes  "blown,"  the  ends  bulge,  and 
the  contents  are  unfit  for  food.  The  process  of  canning  meat  or  vegetables 
is  conducted  somewhat  as  follows:  The  container  is  first  of  all  boiled  to 
kill  any  germs.  The  product  to  be  canned  should  then  be  thoroughly 
sterilized  by  heat,  and  immediately  placed  in  the  container  and  hermet- 
ically sealed.  Some  unscrupulous  manufacturers  use  antiseptics  instead 
of  heat,  much  to  the  detriment  of  the  public  health.  H.  W.  Wiley (3), 
who  made  an  exhaustive  study  of  canned  foods,  says : 

All  manner  of  food  is  canned,  and  that  at  prices  "which  place  it  within  the 
reach  of  the  humblest  pockets.  Preserved  food  has  been  a  great  democratic  fac- 
tor, and  has  nearly  obliterated  one  of  the  old  lines  of  demarcation  between  the 
poor  and  the  wealthy.  Vegetables  out  of  season  are  no  longer  a  luxury  of  the 
rich.  In  the  American  grocery  pineapples  from  Singapore,  salmon  from  British 
Columbia,  fruit  from  California,  peas  from  Prance,  okra  from  Louisiana,  sweet 
corn  from  New  York,  string  beans  from  Scotland,  mutton  from  Australia,  sar- 
dines from  Italy,  stand  side  by  side  on  the  shelves. 

Of  the  dangers  of  poisoning  from  canned  goods,  Wiley  says: 

Vegetables  are  usually  canned  in  the  fresh  state,  and  if  they  are  in  any  degree 
spoiled  at  the  time  the  fact  is  usually  conspicuously  evident  to  the  taste,  so  that 
the  canner  cannot  afford  to  use  them.  Bacterial  action  seldom  occurs  in  the  can 
without  bursting  it  or  rendering  it  unsalable.  Ptomains  may,  however,  develop 
where  the  canned  food  is  allowed  to  stand  for  some  time  after  opening,  though 


METHODS    OF    FOOD    PRESERVATION  7 

even  then  this  is  unlikely  in  the  ease  of  preserved  vegetables.  It  may  be  said, 
therefore,  that  the  principal  risks  to  health  which  may  arise  from  the  use  of 
canned  goods  are  those  due  to  the  use  of  preservatives,  or  to  the  presence  of  the 
heavy  metals,  copper,  tin,  lead  and  zinc.  In  this  country  there  is  no  restriction 
whatever  in  regard  to  the  character  of  the  tin  employed,  and  as  a  result  of  this, 
the  tin  of  some  of  the  cans  has  been  found  to  contain  as  high  as  12  per  cent 
of  lead.  The  analyses  of  numerous  samples  of  solder  employed  show  that  it  con- 
tains fully  50  per  cent  of  lead.  In  addition  to  this  there  is  no  care  taken  to  pre- 
vent the  solder  from  coming  into  contact  with  the  contents  of  the  can.  It  is  a 
rare  thing  to  carefully  examine  the  contents  of  a  can  without  finding  pellets  of 
solder  somewhere  therein. 

Treatment  with  Antiseptic  Chemical  Agents. — The  use  of  various  anti- 
septic and  preservative  tluids  is  designed  to  prevent  activity  of  germs  and 
fermentation.  Sugar,  like  salt,  in  strong  solution  possesses  decided  anti- 
septic powers,  and  hence  the  employment  of  strong  fluids  for  the  preser- 
vation of  fruits,  and  of  sugar  itself  in  making  candied  fruits.  Other 
harmless  preservative  materials  which  are  added  are  oils,  chiefly  service- 
able for  keeping  fish,  and  vinegar  and  spirits  of  wine  for  pickling  such 
products  as  chillies,  tarragon  and  shallot.  Vinegar  is  used  to  preserve 
oysters,  lobsters  and  other  sea  food,  as  well  as  cucumbers,  cauliflower  and 
other  vegetables.  Fish  are  immersed  in  mixtures  of  cider  vinegar  flavored 
with  cloves,  nutmeg,  parsley,  bay-leaf,  onions,  etc.  After  being  "soused" 
once  or  twice,  the  food  is  heated  in  the  fluid  to  140°  F.  Flavoring  sub- 
stances are  added,  and  the  whole  is  put  into  air-tight  jars.  The  fumes  of 
burning  sulphur  are  sometimes  used  as  a  preservative  of  foods,  especially 
fruits.  Acetic  acid,  weak  carbolic  acid  solutions  and  bisulphite  of  calcium 
are  injected  into  the  blood  vessels  of  meat  for  the  same  purpose.  Chlorid 
of  aluminium,  borax,  salicylic  acid  and  other  materials  have  been  exten- 
sively used  for  the  preservation  of  milk. 

Another  method  of  preserving  meat  consists  of  injecting  the  animal, 
the  moment  it  is  killed,  with  a  solution  of  borax,  which  is  so  uniformly 
distributed  through  the  circulation  to  all  the  fibers  of  the  meat,  that  only 
a  very  small  quantity  of  the  antiseptic  need  be  employed.  The  preserva- 
tion of  meat  by  the  antiseptic  action  of  these  substances,  if  used  in  excess, 
is  apt  to  endanger  the  normal  digestive  functions,  and  besides  render  the 
meat  less  nutritious.  The  use  of  many  of  these  chemical  agents  has  been 
forbidden  by  federal  enactment,  and  their  use  in  all  forms  of  animal  food 
is  everywhere  condemned. 


FOOD  PRESEKVATION 


REFERENCES 


1.  Yeo,  Burney.     Physiological  Chemistry. 

2.  Wiley,  Harvey  W.     Foods  and  Their  Adulteration. 

3.     .    U.  S.  Dept.  Agric,  Bull.  13. 


CHAPTER   II 

PRESERVATION    OF    FOODS    BY    DEHYDRATION 
H.    Edwin    Lewis,    M.D. 

Dehydration:   Value;   Methods. 

Dehydration  of  Animal  Foods:   Milk,  Casein;  Eggs;  Meat;   Fish. 

Dehydration  of  Fruits:  Prunes;  A.pricots;  Peaches;  Plums;  Apples;  Un- 
usual Fruits — Persimmons,  Copra,  etc. 

Dehydration  of  Vegetables:  Potatoes;  Corn;  Beans — Soy  Bean,  Lima 
Bean;   Cabbage,  Parsnips,  Turnips,  etc.;   Use  in  Allied  Armies. 

Value  of  Process  of  Dehydration — It  will  be  quite  in  place,  before  going 
into  details  regarding  the  question  of  dehydration,  to  discuss  briefly  the 
whole  subject  from  a  broad  outlook.  First,  stress  should  be  laid  on  the 
fact  that  dehydration  is  the  surest  means  known  of  preserving  foodstuffs, 
especially  those  of  the  vegetable  kingdom,  for  an  indefinite  length  of  time 
without  injury  to  the  products  thus  treated.  Dehydration,  indeed,  is  a 
most  effective  mode  of  really  preserving  vegetables  and  fruits,  and  to  a 
lesser  extent  animal  foods ;  the  cellular  membrane  of  vegetable  matter  is 
in  no  respect  injured  by  the  process  of  evaporation  when  properly  car- 
ried out. 

The  vitamine  element,  now  known  to  be  so  essential  to  the  conservation 
of  good  health,  is  preserved  in  vegetables  which  are  subjected  to  Amer- 
ican evaporating  methods.  Moreover,  the  palatability  and  flavor  of  vege- 
tables dehydrated  in  this  manner  are  not  impaired ;  in  consequence,  vege- 
tables and  fruits  dried  by  this  process  retain  to  a  really  remarkable  extent 
their  normal  flavor  and  fresh  taste  when  prepared  for  the  table.  Fur- 
thermore, since  their  cellular  tissue  is  uninjured,  they  resume  their  natu- 
ral appearance  soon  after  they  have  been  soaked  in  water. 

Proper  dehydration  is  perhaps  the  most  wonderful  means  of  preserving 
food,  particularly  vegetable  food,  yet  devised.  This  process  does  not  harm 
the  nutritive  properties  of  the  food.     It  represents  the  utmost  food  econ- 

9 


10      PRESERVATION    OF   EOODS    BY    DEHYDRATION 

omy,  and  the  translation  of  its  principles  into  practice  is  peculiarly  ap- 
plicable to  the  present  juncture,  when  war  makes  it  incumbent  upon  all 
to  avoid  waste  and  to  save  the  food  supply  by  every  known  means. 

Few  persons  have  any  idea  of  the  fearful,  almost  criminal,  waste  of 
vegetables  and  fruits  in  this  country.  We  are  certainly  a  careless  and  im- 
provident people.  This  is  no  doubt  due  largely  to  our  living  in  a  country 
of  almost  unlimited  resources,  where  prosperity  has  always  reigned  and 
where  stint  or  lack  of  food  has  been  unknown. 

The  United  States  Department  of  Agriculture  has  stated  that  in  the 
neighborhood  of  50  per  cent  of  the  vegetables  and  fruits  gTown  here  never 
reach  the  consumer's  table,  and  according  to  R.  G.  Skerrett(l),  it  is 
equally  certain  that  the  greater  part  of  the  product  thus  sacrificed  does 
not  leave  the  farm  or  orchard.  This  unfortunate  happening  is  due  to 
various  causes — lack  of  transportation,  the  state  of  the  market,  but  mainly 
because  only  the  very  best  fruits  and  vegetables  will  pass  final  muster  or 
will  be  in  a  condition  which  will  ensure  their  sale  at  a  profitable  figure. 
All  these  difiiculties  might  be  overcome  and  could  be  overcome  if  facili- 
ties for  proper  dehydration  were  available. 

It  has  been  pointed  out  that  scientifically  dehydrated  vegetables  and 
fruits  can  be  conserved  for  a  practically  unlimited  period  of  time.  It 
may  also  be  stated  that  these  same  food  products  can  be  sold  to  the  con- 
sumer at  a  price  considerably  below  that  of  fresh  products,  which  can  only 
be  obtained  at  certain  periods  of  the  year,  and  even  below  the  price  of 
canned  foods  of  this  nature.  For  instance,  one  pound  of  kidney  beans 
dried  artificially  costs  ten  cents,  a  pint  can  of  these  same  beans  costs  fif- 
teen cents.  One  pound  of  the  dried  beans  will  go  as  far  as  four  cans,  in 
addition  to  providing  a  good  deal  more  nutriment. 

A  weight}'  reason  why  Germany  has  been  able  to  hold  out  so  long  in 
spite  of  the  blockade  may  be  attributed  to  a  large  extent  to  the  fact  that 
she  had  adopted,  long  before  the  war,  a  widespread  system  of  preserving 
by  dehydrating  processes  vegetables  and  fruits  that  otherwise  would  have 
been  lost.  Immediately  before  the  war,  there  were  more  than  four  hun- 
dred dehydrating  establishments  in  Germany,  and  since  hostilities  com- 
menced, many  more  have  been  built.  At  the  present  time  all  the  German 
cities  of  any  size  contain  evaporating  plants,  by  which  means  the  surplus 
stock  of  farm  products  has  been  saved  to  tide  the  population  over  the 
lean  days. 

The  public  must  be  taught  to  realize  the  necessity  for  economy  in  food 
and  should  also  be  taught  the  value  of  dehydration  as  a  factor  in  achieving 
this  object.     There  is  always  a  certain  amount  of  prejudice  against  novel 


VALUE    OF    PEOCESS    OF    DEHYDRATION  U 

ideas.  Canuiug,  at  one  time,  was  regarded  with  hostility,  and  cold  storage 
was  and  is  still  looked  upon  with  a  good  deal  of  distrust.  Cold  storage 
when  not  abused  is  a  highly  satisfactory  method  of  preserving  food,  and 
canning  possesses  conspicuous  merits.  Perhaps  the  American  people  have 
contracted  the  "canning  habit,"  or  rather  the  habit  of  eating  canned  foods, 
with  too  great  facility  because  canned  food  provided  such  an  easy  method 
of  satisfying  the  food  wants  of  the  body.  At  any  rate,  a  good  deal  of 
the  prejudice  which  existed  against  canned  foods  has  vanished.  Now 
there  is  need  for  an  educational  propaganda  to  enlighten  the  public  as  to 
the  nutritive  and  economic  value  of  dehydrated  foodstuffs. 

DEHYDRATION  OF  VEGETABLES.— Dehydration  as  applied  to  vege- 
tables is  as  yet  in  its  swaddling  clothes  and  has  only  just  cut,  metaphor- 
ically speaking,  its  first  teeth.  True  it  is,  that  the  dried  fruit  industry, 
which,  by  the  way,  is  almost  as  old  as  the  immemorial  hills,  is  established 
on  a  firm  basis,  but  the  dehydration  of  the  common  or  garden  vegetables, 
as  potatoes,  cabbage,  spinach,  onions  and  so  forth,  has  not  found  favor 
in  the  eyes  of  the  people  at  large.  The  reason  for  this  is  that  the  man  in 
the  street  does  not  understand  the  situation  and  is  either  indifferent  to 
dehydrated  foods  or  is  mildly  and  ignorantly  prejudiced  against  them.  If 
he  could  be  taught  the  significance  of  modern  dehydrating  methods  and 
be  shown  that  dehydrated  foods  are  superior  to  canned  or  cold  storage 
foods — in  fact,  almost  identical  with  the  products  in  a  fresh  state — and 
that  only  by  the  dehydration  of  vegetables  can  conditions  be  handled  suc- 
cessfully, he  would  assuredly  alter  his  attitude  toward  this  question. 

Here  are  some  further  reasons  why  dehydrated  vegetables  fill  a  place 
which  cannot  be  filled  by  vegetables  subjected  to  any  other  preservative 
process. 

First,  some  dehydrated  vegetables,  when  scientifically  prepared,  retain 
their  original  flavor  more  fully  than  when  canned  in  the  usual  fashion. 
Two  of  the  most  important  of  the  canned  American  vegetables,  com  and 
string  beans,  are  outstanding  examples  of  the  truth  of  this  statement.  If 
beans  and  corn,  which  have  been  dehydrated  under  exactly  correct  condi- 
tions, are  soaked  and  cooked,  they  retain  their  natural  flavor,  which,  on 
the  other  hand,  is  much  impaired  by  the  ordinary  canning  process. 

As  H.  el.  Burgess  (2)  has  pointed  out,  some  factor  in  the  dehydrating 
process — possibly  oxidation  has  something  to  do  with  it — develops  flavors 
which  no  other  process  will  develop.  All  vegetables  are  not  improved  in 
flavor  by  means  of  dehydration ;  generally  speaking,  however,  the  flavor 
of  no  vegetable  is  impaired  by  this  process  as  it  is  by  canning.  A  lack  of 
understanding  on  the  part  of  the  public  as  to  the  merits  of  dehydration 


12       PltESEEVATION    OF    FOODS    BY    DEHYDRATION 

is  largely  responsible  for  the  relatively  slow  progress  of  the  industry.  In 
order  to  render  the  public  more  cognizant  of  the  economic  and  other 
obvious  advantages  of  dehydration,  especially  of  the  dehydration  of  vege- 
tables, it  will  be  necessary  to  induce  housewives  to  take  an  intelligent 
interest  in  the  matter.  This  result  will  only  be  brought  about  by  the 
prosecution  of  a  publicity  campaign  showing  the  advantages  of  dehydra- 
tion and  popularizing  food  products  treated  by  this  process. 

We  have  dwelt  upon  and  endeavored  to  drive  home  as  forcibly  as  pos- 
sible the  potentialities  of  a  universal  system  of  dehydrating  vegetables, 
because  vegetables  best  lend  themselves  to  the  method.  We  feel  convinced 
that  if  this  means  of  preserving  them  is  generally  adopted,  a  great  ad- 
vance will  have  been  made  in  economizing  and  conserving  the  food  supply 
as  well  as  in  providing  a  reserve  of  nutritive  foodstuff  in  case  of  need. 
The  details  of  the  dehydration  of  vegetables  will  be  exhaustively  dealt 
with  at  the  end  of  this  chapter. 

The  dehydration  of  fruits  is  a  long  established  industry,  as  is  also 
the  drying  of  meat;  desiccation  of  milk  has  been  carried  on  during  a 
period  of  several  years.  These  subjects,  therefore,  will  only  be  discussed 
under  their  several  heads. 

APPLICATION    OF    DEHYDRATION    TO    SPECIAL    FOODS 
DESICCATION    OF    MILK 

With  regard  to  the  desiccation  of  milk,  it  may  be  said  that  the  prac- 
tical process  of  converting  cow's  milk  into  dry  milk  powder  is  a  compara- 
tively recent  discovery.  Attempts  were  made  in  the  middle  of  the  last 
century  to  condense  milk  to  a  stage  of  dryness ;  these  resulted  in  failure. 
According  to  Levi  Wells (3),  a  consular  report  from  Sweden,  dated  !N^o- 
vember  20,  1901,  refers  to  a  process  reported  to  the  Academy  of  Agricul- 
ture, a  meeting  of  which  was  held  in  Stockholm  in  that  month.  The 
New  York  Produce  Review  and  American  Creamery,  January  1,  1902, 
comments  on  a  similar  process  used  in  America,  and  claims  that  it  was 
discovered  prior  to  the  Swedish  process. 

Historical  Development  of  the  Process — Dr.  Eric  Pritchard(4)  states 
that  in  the  year  1903  Mr.  S.  Amundsen  succeeded  in  employing  on  a 
commercial  scale  a  method  of  desiccation  invented  a  few  years  previously 
by  Dr.  G.  Ekenberg.  Dr.  Pritchard  is  the  greatest  authority  on  dried 
milk  in  Great  Britain,  and  one  of  the  first  in  the  world.  In  the  course 
of  the  following  account  of  desiccated  milk,  his  work  just  referred  to 
will  be  largely  drawn  upon  for  facts  and  views.     The  establishment  of 


APPLICATION    OP    DEHYDRATION    TO    POODS  13 

Mr.  Aiiiuiidsen's  factory  in  Christiania  was  almost  the  necessary  conse- 
quence of  the  fact  that  in  tliis  part  of  Sweden  the  butter  industry,  entail- 
ing a  large  and  unavoidable  loss  of  by-products  and  residuals,  was  of  con- 
siderable importance.  The  outcome  of  this  condition  was  the  invention 
of  the  Ekenberg  process.  At  first  this  process  was  by  no  means  an  un- 
qualified success,  chiefly  because  the  method  could  be  used  only  for  the 
desiccation  of  milk  from  which  the  butter  fat  had  been  extracted.  How- 
ever, in  the  course  of  time  the  Ekenberg  system  was  so  greatly  improved 
that  manufacturers  were  able  to  produce  desiccated  milk  on  a  commercial 
scale  without   the   preliminary   removal   of  the   cream. 

Present  Methods. — So  many  improvements  have  since  been  made  that 
at  the  present  moment  there  are,  according  to  Pritchard,  three  distinct 
methods  of  manufacture,  each  good  in  its  way  and  each  possessing  special 
advantages.  Levi  Wells,  on  the  other  hand,  says  that  there  are  two  dis- 
tinct methods  of  drying  milk  from  which  several  systems  have  been 
evolved. 

EKENBERG  PROCESS.— As  described  by  Pritchard,  the  Ekenberg 
process  consists  in  the  partial  condensation  of  milk  at  a  low  temperature 
under  reduced  pressure,  and  its  subsequent  desiccation  within  the  interior 
of  cylinders  heated  to  a  comparatively  low  teiSaperature.  The  milk  solidi- 
fies into  a  crystalline  mass  on  the  surface  of  the  cylinders,  which  are  kept 
in  constant  rotation.  This  mass  is  subsequently  broken  up  and  pulver- 
ized. The  method  is  largely  employed  in  France  and  in  other  parts  of 
Europe. 

JUST-HATMAKER  PROCESS.— In  Great  Britain  the  method  usually  em- 
ployed is  that  known  as  the  Just-Hatmaker  process.  In  this  method  the 
previously  concentrated  milk  is  spread  on  the  outer  surface  of  rotating 
cylinders,  which  are  heated  to  160°  C.  by  steam.  The  thin  film  of  milk 
dries  very  rapidly  on  the  highly  polished  surfaces,  and  when  dry  is 
scraped  off  by  sharp  knife  blades  and  subsequently  pulverized  as  in  the 
Ekenberg  process. 

BEVENOT  DE  NEVEU  PROCESS.— A  third  process,  generally  known  as 
the  Bevenot  de  Neveu  method,  consists  in  concentrating  the  milk  in  vacuo 
and  at  a  low  temperature,  and  then  forcing  it  under  high  pressure,  250 
atmospheres,  through  minute  perforations  in  a  metal  disk  into  the  drying 
chamber.  The  nebula  of  homogenized  milk  is  then  surrounded  by  an  en- 
velope of  dry  hot  air  and  swept  across  the  chamber.  Owing  to  the  fine 
slate  of  division  of  the  particles  in  which  the  condensed  milk  is  pre- 
sented, and  to  its  intimate  contact  with  dry  air,  the  milk  is  almost  in- 
stantaneously desiccated,  and  falls  as  an  extremely  fine  powder  to  the 


14     prp:servation  of  foods  by  dehydration 

floor  of  the  chamber.  The  moisture  thus  evaporated  is  carried  off  as  a 
cloud  of  steam,  while  the  snow-like  desiccated  milk  is  rapidly  swept  up 
from  the  floor  and  packed  in  tins  or  other  receptacles. 

The  rapidity  with  which  the  concentrated  milk  is  evaporated  in  the 
drying  chamber  is  the  distinguishing  feature  of  this  method.  So  swift 
is  the  evaporation  that  the  water  is  removed  from  the  coagulable  ingredi- 
ents, such  as  the  whey  products,  before  they  have  time  to  become  coagu- 
lated by  the  heat.  In  fact,  the  coagulable  substances  which  have  been  so 
desiccated  can  be  reconstituted  by  adding  water. 

By  the  Bevenot  de  Neveu  process  milk  and  whey  can  be  reduced  to 
a  very  dry  powder  containing  no  more  than  1  per  cent  of  water,  appar- 
ently without  alteration  of  their  physical  properties;  that  is  to  say,  none 
of  the  enzymes  or  vitamines  appear  to  be  destroyed.  The  milk,  when  re- 
constituted with  water,  can  be  coagiilated  by  rennet  or  heat,  precipitated 
with  acids,  and  soured  by  lactic  acid  ferments,  just  as  is  the  case  with 
milk  fresh  from  the  cow.  Moreover,  when  allowed  to  stand,  the  cream 
will  slowly  rise  as  it  does  in  fresh  milk  which  has  been  homogenized. 
As  Pritchard  says,  these  results  are  in  his  opinion  very  valuable,  for  they 
refute  the  chief  argument  usually  brought  against  desiccated  milks — that 
they  are  so  profoundly  altered  by  the  heat  to  which  they  have  been  sub- 
jected in  the  course  of  manufacture  that  they  no  longer  possess  those  sub- 
tle and  vital  properties  which  are  supposed  to  be  essential  to  good  nutri- 
tion. 

If  the  results  of  the  Bevenot  de  Neveu  method  of  desiccating  milk 
are  as  Pritchard  thinks  they  are,  and  he  is  a  close  and  trained  observer, 
and  if  none  of  the  enzymes  or  vitamines  are  destroyed,  the  process  is 
an  excellent  one.  The  odor,  however,  of  the  Bevenot  de  Neveu  milk 
is  slightly  tallowy,  due  to  the  oxidation  of  the  fat,  a  result  which  seems 
to  follow  from  the  fine  state  of  division  in  which  the  fat  particles  are  pre- 
sented to  the  oxygen  of  the  air.  "While  this  oxidation  in  no  way  impairs 
the  nutritive  value  of  the  milk,  it  detracts,  of  course,  from  its  popularity. 
This  is  unfortunate,  as  in  all  other  respects  it  is  superior,  in  Pritchard's 
opinion,  to  other  varieties  of  desiccated  milk. 

STAUF  PROCESS. — Robert  Stauf,  of  Posen,  Germany,  devised  a  process 
for  producing  dry  powders  from  blood,  milk,  etc.,  by  atomizing  these 
liquids  into  supplementary  regulated  currents  of  heated  air.  The  amount 
of  air  and  heat  supplied  was  sufficient  to  completely  absorb  and  vaporize 
the  moisture  of  the  liquid.  The  resulting  dry  powder  was  separated  from 
the  moisture-laden  air  by  means  of  a  screen.  The  screen  retained  the 
powder  and  the  air  passed  off  through  the  screen.    The  Staiif  process  was 


APPLICATION    OF    DEHYDRATION    TO    FOODS  15 

the  first  spray-drying  process  to   be  commercially   used   in   the   United 
States. 

Comparison  of  Kinds  of  Desiccated  Milk. — The  appearances  of  the 
cylinder-dried  and  air-dried  milks  are  distinctive.  The  color  of  Just- 
Hatmaker  milk  is  biscuit  yellow,  that  of  Eevenot  de  Neveu  milk  of  a 
peculiarly  snow-like  white.  When  allowed  to  stand,  the  fat  rises  in  the 
former  as  a  yellow  oil,  in  the  latter  as  a  rich  cream.  The  odor  of  the 
cylinder-dried  milk  is  agreeable  and  distinctly  biscuity. 

Fatless  Milk. — Levi  Wells  is  of  the  opinion  that  drying  milk  from 
which  the  fat  has  been  removed  seems  to  be  a  success.  Milk  is  changed 
by  the  drying  process  from  a  quickly  perishable,  bulky  substance,  incon- 
venient to  transport,  into  a  product  requiring  little  space.  Its  keeping 
properties  are  practically  unlimited,  and,  furthermore,  it  is  a  safe  food, 
free  or  almost  free  from  hurtful  germs. 

According  to  Wells,  probably  over  90  per  cent  of  the  milk  powder  pro- 
duced at  the  present  time  is  made  of  skim  milk.  From  one  hundred 
pounds  of  whole  milk  of  average  quality,  3.5  pounds  of  butter  fat  and 
nine  pounds  of  dry  skim  milk  can  be  secured.  Dry  skim  milk  powder 
has  the  appearance  of  ordinary  flour  made  from  grain.  This  grade  of 
dried  milk  possesses  in  a  condensed  form  all  the  valuable  properties  of 
fresh,  sweet,  skim  milk.  It  can  be  used  in  this  form  by  bakers  and  con- 
fectioners, or,  if  desired,  it  can  be  converted  into  its  original  liquid  state 
by  adding  the  amount  of  water  that  has  been  extracted  from  it.  Wells 
is  not  so  enthusiastic  concerning  desiccated  whole  milk.  He  undoubtedly 
refers  to  America  when  he  states  that  most  of  the  milk  desiccated  is  skim 
milk,  as  Pritchard,  although  he  writes  solely  on  infant  feeding,  points 
out  that  in  Great  Britain  dried  milks,  whether  prepared  by  the  cylinder 
or  the  air  process,  are  usually  sold  in  throe  qualities:  "full  fat"  milk, 
from  which  no  cream  has  been  extracted  before  drying;  "half  cream," 
from  which  part  of  the  fat  has  been  removed ;  and  as  desiccated  milk,  from 
which  all  the  cream  has  been  separated. 

Reconstruction  of  Desiccated  Milk  for  Infants. — If  it  is  desired  to  repro- 
duce undiluted  cow's  milk,  it  can  be  accomplished  by  prescribing  so  many 
ounces  of  the  reconstituted  dried  milk  made  up  in  the  proportion  of  one 
dram  of  the  powder  to  one  ounce  of  water,  and  modified  for  infant  con- 
sumption. If  dried  milk  is  to  be  modified  to  correspond  to  breast  milk 
in  all  its  constituent  parts,  including  its  content  of  whey  products,  these 
latter  must  be  added  independently. 

The  Eevenot  de  Neveu  process  of  desiccation  produces  a  whey  powder 
which  when  reconstituted  with  water  almost  exactly  reproduces  the  orig- 


16      PEESEKVATION    OF    FOODS    BY   DEHYDRATION 

inal  whey  from  which  it  was  prepared.  By  an  appropriate  combination 
of  dried  milk,  whey  powder,  sugar  and  cream,  a  humanized  milk  can  be 
prepared  which  has  a  percentage  composition  the  same  as  human  milk, 
namely — caseinogen,  0.5  per  cent;  whey  proteins,  1  per  cent;  sugar,  6.5 
per  cent,  and  fat,  3.5  per  cent.    The  formula  is  as  follows: 

Full  Cream  Dried  Milk 3       teaspoonfuls 

Dried  Whey  Powder 21/2  tablespoonfuls 

Sugar 2       teaspoonfuls 

Thick  Cream    1       oz. 

Water  to 1       pt. 

This  is  a  very  valuable  substitute  for  breast  milk. 

Strong,  healthy  infants,  who  have  been  accustomed  to  take  ordinary 
cow's  milk,  or  who  have  been  gradually  accustomed  to  larger  quantities 
of  caseinogen  by  a  graduated  course  of  feeding,  thrive  well  on  a  mixture 
of  the  following  formula:  proteins,  2.5  per  cent;  sugar,  6.5  per  cent;  fat, 
3.5  per  cent.     This  is  prepared  by  combining: 

Full  Cream  Dried  Milk 2       oz. 

Sugar    1/2  oz. 

Thick   Cream 1^  oz. 

Water  to  make  the  pint 

For  the  feeding  of  poor  infants  and  for  the  sake  of  economy,  Pritchard 
uses  desiccated  separated  milk,  which  he  modifies  by  adding  supplemen- 
tary fat  and  by  sweetening  with  a  small  quantity  of  sugar.  He  employs 
as  a  fat  an  emulsion  of  linseed  oil.  The  formula  for  preparing  20  ounces 
of  separated  dried  milk  and  an  emulsion  of  linseed  oil  is  as  follows: 

Separated  Dried  Milk 11/^  oz. 

Emulsion  of  Linseed  Oil  (50  per  cent  fat)  .  .  11^  oz. 

Sugar    ; 1/2  oz. 

Water  to  make  pint 

Advantages  of  Desiccated  Milk — Pritchard  believes  with  Professor 
Porcher  that  desiccated  milk  is  'la  vache  dans  le  placard"  If  you  have 
dried  milk,  you  are  as  well  off  as  if  you  kept  a  cow  in  the  larder  ready 
to  be  milked  at  any  moment.  Dairy  milk  deteriorates  and  is  liable  to 
infection  almost  from  the  moment  it  is  milked  up  to  the  moment  of  con- 
sumption. Desiccated  milk  represents  milk  which  has  only  deteriorated 
between  the  time  of  milking  and  desiccation.  This  time  may  be  short. 
The  range  of  usefulness  of  desiccated  milk  is  obviously  a  wide  one.     It 


APPLICATION    OF    DEHYDRATION    TO    FOODS         17 

possesses  many  advantages.  Its  keeping  properties  are  to  all  intents  and 
purposes  unlimited ;  it  is  easily  transported ;  it  is  convenient  to  handle 
and  is  ready  for  immediate  use  under  any  circumstances  and  at  all  times ; 
it  is  sterile ;  and  its  cost  is  somewhat  less  than  the  dairy  milks.  When  the 
desiccation  is  properly  done,  the  nutritive  properties  of  the  milk  are  pre- 
served. Skim  milk  is  more  easily  and  successfully  desiccated  than  milk 
from  which  the  fat  has  not  been  removed,  yet  whole  milk  can  be  desic- 
cated with  success,  although  its  keeping  properties  are  not  equal  to  those 
of  dried  skim  milk.  For  the  various  reasons  already  given,  desiccated 
milk  is  especially  well  adapted  for  use  in  armies,  hotels,  restaurants, 
boarding  houses  and  hospitals.  As  the  public  gains  a  better  conception 
of  its  value,  its  use  is  certain  to  be  greatly  increased. 

The  average  composition  of  whole  milk  powder  is  as  follows:  solids, 
96.3;  ash,  5.6;  fat,  26.8;  protein,  32.0;  lactose,  31.9.  Analysis  of  skim 
milk  powder  shows  solids,  91.7;  ash,  6.9;  fat,  1.7;  protein,  33.8;  lactose, 
49.3. 

DEHYDRATION    OF    CASEIN 

According  to  Cautley(5),  dried  casein  is  a  very  nutritious  food,  on 
a  par  with  the  cheese  made  from  skim  milk.  It  is  enormously  valuable 
in  that  it  can  be  added  to  other  foods,  thus  enhancing  their  protein  value. 
Casein  is  purin  free,  does  not  clot  and  is  easily  digested  and  absorbed. 
It  is  indicated  in  all  affections  in  which  additional  protein  is  needed j  and 
is  useful  as  a  means  of  giving  phosphorus  in  organic  combinations.  It 
is  especially  valuable  in  the  treatment  of  acid  dyspepsia,  for  the  protein 
fixes  the  acid. 

DRIED    EGGS 

Special  investigations  of  the  freezing  and  drying  of  eggs  and  of  the 
two  general  methods  in  use  for  preserving  eggs  when  removed  from  their 
shells  have  been  made  by  Pennington (6),  and  by  Stiles  and  Bates (7). 

There  is  no  doubt  that  the  drying  of  eggs  is  an  economically  desirable 
procedure  provided  that  the  eggs  are  fresh  and  wholesome  and  that  they 
are  handled  with  care. 

Pennington  has  pointed  out  that  the  handling  of  eggs  from  which  the 
shells  have  been  removed  is  analogous  in  many  respects  to  the  handling 
of  milk,  and  should  be  characterized  by  the  most  scrupulous  cleanliness 
from  beginning  to  end.  Bacteriological  investigation  will  best  demon- 
strate the  sources  of  contamination,  which  can  be  eliminated  almost  wholly 
by  the  adoption  and  enforcement  of  strict  sanitary  measures,  such  as  clean- 
liness of  surroundings  and  of  the  workers,  frequent  cleansing  and  drying 


18       PRESEKVATION    OF    FOODS    BY    DEHYDIIATIOI^ 

of  the  fingers,  use  of  appliances  and  containers  which  have  been  thoroughly 
sterilized,  and  prompt  drying  of  the  egg  after  the  shell  has  been  removed. 

According  to  Stiles  and  Bates,  the  drying  of  eggs  expels  over  nine- 
tenths  of  the  water  originally  present.  One  pound  of  the  dry  product  rep- 
resents the  solids  of  from  36  to  40  average-sized  eggs. 

Stiles  and  Bates  describe  four  general  methods  of  drying  eggs  in  com- 
mercial use.  Of  these  methods  the  following,  known  as  the  "instantaneous 
method,"  is  perhaps  the  most  satisfactory.  The  liquid  eggs  are  sprayed 
into  a  heated  chamber  at  a  temperature  of  about  160  F.,  where  they  are 
immediately  reduced  to  a  fine  powder  which  usually  contains  from  3  to 
5  per  cent  of  moisture.  This  powder  is  carried  by  currents  of  air  through 
cotton  bags  or  other  filtering  devices,  and  finally  falls  into  bins,  ready  to 
be  packed  in  suitable  containers.  Other  processes  of  drying  eggs  are 
known  as  the  "Belt"  method,  the  "Disk"  method  and  the  "Tray"  or 
"Board"  method.  Egg  substance  thoroughly  dried,  preferably  by  the  in- 
stantaneous process,  will  keep  in  a  satisfactory  condition  in  almost  any 
climate,  for  an  unlimited  period  of  time  and  retain  all  the  nutritive  value 
of  the  fresh  egg. 

Stiles  and  Bates,  as  the  result  of  many  experiments  to  determine  the 
bacterial  content  of  frozen  and  dried  fresh  eggs,  came  to  the  following 
conclusions:  Under  normal  conditions,  strictly  fresh  dried  eggs  contain 
few  if  any  bacteria,  and  no  appreciable  numbers  of  B.  coli  in  1  c.c.  quan- 
tities. Consequently,  it  may  be  stated  that  if  the  eggs  are  fresh,  if  all  the 
necessary  sanitary  conditions  are  fulfilled  when  preparing  them  for  dry- 
ing, and  if  the  instantaneous  method  is  employed,  the  eggs  thus  treated 
will  preserve  their  nutritive  properties  for  an  indefinite  length  of  time 
and  will  constitute  an  important  reserve  supply  of  food. 

THE   PRESERVATION   OF  MEAT  BY  DEHYDRATION 

Ancient  and  Modem  Methods  of  Drying  Meats The  drying  of  meat  is 

a  very  ancient  custom.  Almost  as  soon  as  our  prehistoric  ancestors  were 
enabled  by  means  of  hunting  to  gratify  their  natural  instinct  for  animal 
food,  they  preserved  some  of  the  meat  or  fish  thus  obtained  by  drying  it 
in  the  sun  and  then  storing  it.  Even  before  flesh  food  was  known  to 
them,  they  were  accustomed  to  dry  insects  in  the  sun,  and  many  of  the 
primitive  peoples  still  existing  follow  similar  customs. 

In  the  dry  climates  of  South  America  or  of  South  Africa,  and  on  our 
Western  plains,  meat  is  cut  into  thin  strips  and  hung  out  of  doors  to  be 
exposed  to  the  direct  action  of  the  sun's  rays.    In  a  short  time  the  moisture 


APPLICATIOX    OF    DEIIYDRATIOX    TO    FOODS         19 

has  disappeared  and  the  hard,  dry  pieces  will  keep  indefinitely,  or,  at 
any  rate,  as  long  as  they  are  kept  dry.  The  meat  retains  a  fair  degree  of 
palatability  and  practically  all  of  its  nutritive  properties.  In  the  West 
this  is  known  as  "jerked  beef,"  and  in  South  Africa  as  "biltong."  "Pem- 
mican,"  a  food  largely  used  by  explorers,  is  a  mixture  of  dried  lean  meat, 
fat,  and  sometimes  dried  fruits,  such  as  currants  and  raisins. 

TELLIER  METHOD. — Drying  is  not  so  well  adapted  to  meats  as  to  vege- 
tables and  fruits.  Dried  meats  lose,  to  a  considerable  extent,  their  natural 
flavor.  Perhaps  the  best  method  of  preserving  meat  by  dehydration  is 
that  devised  by  the  celebrated  French  refrigeration  engineer,  Charles  Tel- 
lier,  who  has  described  the  process  in  his  book,  "La  Conservation  de  la 
Viande."  A.  F.  Burger (8)  gives  an  account  of  the  method.  By  this 
process  the  meat  is  dehydrated  in  vacuo,  without  the  employment  of  heat 
or  the  use  of  any  agents  which  might  alter  its  properties,  as  is  the  case 
when  meat  is  preserved  by  pickling  or  by  drying  with  heat.  Meat  dehy- 
drated in  vacuo  loses  most  of  its  water  and  retains  its  natural  properties. 
Its  culinary  properties  are  not  prejudicially  affected  nor  is  its  nutritive 
value  impaired,  since  no  essential  alteration  of  the  tissue  or  of  the  juices 
occurs. 

The  degree  of  vacuum  to  be  applied  in  removing  the  water  should  be 
as  near  absolute  as  possible;  in  any  event  the  pressure  remaining  in  the 
evaporating  chamber  should  not  be  above  4  or  5  millimeters  of  mercury 
and  the  vacuum  should  be  kept  up  for  12  to  24  hours.  The  method  em- 
ployed by  Tellier  was  as  follows :  An  apparatus  is  constructed,  consisting 
of  two  strong  cylindrical  containers,  each  surrounded  by  a  water  jacket 
for  the  purpose  of  maintaining  a  desired  temperature.  These  two  recep- 
tacles are  connected  by  a  pipe  passing  out  at  the  top.  The  larger  of  the 
two  vessels  is  filled  with  the  meat  to  be  dried,  placed  upon  trays.  The 
other  vessel  is  filled  with  coke  or  other  inert  spongy,  porous  material  which 
is  kept  wet  by  a  solution  of  caustie  potash. 

After  the  air  has  been  drawn  out  of  the  system  by  means  of  an  ordi- 
nary air  pump,  carbonic  acid  gas  is  turned  in  and  later  removed  by  the 
pump.  This  procedure  takes  out  the  last  traces  of  air.  The  residue  of 
carbonic  acid  gas  is  then  absorbed  by  the  caustic  potash  solution  which 
impregnates  the  coke,  the  result  being  a  very  perfect  vacuum.  The  process 
is  said  to  be  inexpensive  and  to  require  but  little  hand  labor.  Three  ad- 
vantages of  the  method  are  stated,  (a)  The  meat  preserved  in  this  man- 
ner keeps  even  when  exposed  to  the  air.  For  all  practical  purposes  it  is 
sterile,  since  the  organisms  contained  therein  are  either  killed  by  the  de- 
hydration or  are  so  weakened  thereby  that  they  cannot  vegetate  or  multiply 


20       PKESERVATION    OF    FOODS    BY    DEHYDRATION 

on  account  of  the  lack  of  moisture,  (b)  Having  been  cut  into  suitable 
pieces  before  preparation,  it  may  be  easily  handled  in  small  shops,  (c) 
Meat  thus  treated  can  be  much  more  easily  transported  than  fresh  meat. 

POWDERED  MEATS.— Powdered  meats  are  prepared  by  complete  des- 
iccation, and  products  of  this  nature  are  found  upon  the  market  in  a  finely 
ground  form.  Meat  powders  are  made  from  fresh  meats  in  their  natural 
state  and  also  from  artificially  digested  meats/ 

Italian  Method  foe  Powdering  Meat. — Some  four  years  ago  an 
Italian  inventor  perfected  a  process  for  preparing  beef  meal.  Meat  treated 
by  this  process  is  said  to  retain  the  characteristic  taste  and  aroma  of  ordi- 
nary beef.  By  this  process  the  beef  is  dried  at  a  low  temperature ;  that 
part  of  the  vapors  which  contain  the  aroma  substances  is  collected,  con- 
densed and  added  to  the  dried  beef  after  the  latter  has  been  properly 
ground.  Beef  prepared  by  this  method  is  said  to  have  unlimited  keeping 
properties.  It  can  be  used  in  exactly  the  same  way  as  ordinary  beef  for 
soups  or  in  combination  with  vegetables. 

Disadvantages  of  Meat  in  Powdered  Form. — Dehydration  of  meat 
or  its  reduction  to  powder,  however,  impairs  its  flavor  and  renders  it  less 
palatable.  In  consequence,  meat  treated  by  these  processes  is  not  likely 
to  become  widely  popular.  Circumstances  may  occur  in  which  dehydrated 
or  powdered  meat  may  be  extremely  useful,  indeed,  almost  essential,  but 
in  everyday  life  dehydrated  or  powdered  meat  will  not  have  a  vogue.  The 
dehydration  of  vegetables,  on  the  other  hand,  will  probably  revolutionize 
the  food  situation.  It  is  mainly  this  form  of  dehydration,  therefore,  that 
will  be  discussed  most  exhaustively  and  upon  which  emphasis  will  be 
chiefly  laid  in  our  consideration  of  the  subject. 

DRIED    FISH 

A  good  deal  of  fish  is  sun-dried,  but  at  present  there  are  no  artificial 
modes  of  dehydrating  fish.  An  immense  quantity  of  fish  is  cured  and 
incidentally  dried,  but  this  is  not  dehydration.  There  is  a  dried  fi.sh 
powder  made  in  Greenock  from  white  fish,  mainly  protein;  dehydration, 
however,  is  not  usually  applied  to  fish. 

DRIED    FRUITS 

The  drying  of  fruits  is  an  extremely  ancient  procedure.  It  was  the 
custom  in  primitive  days  and  by  primitive  peoples  for  fruits  to  be  pre- 
served by  extracting  the>  moisture  or  a  large  proportion  of  the  water  con- 
tent, through  exposure  to  the  action  of  the  sun.     It  appears  likely  that 


APPLICATION    OF    DEIIYDEATIOX    TO    FOODS         21 

fruits  were  first  dried  in  warm  countries,  but  the  custom  lias  long  pre- 
vailed among  the  inhabitants  of  temperate  and  northern  latitudes.  In 
this  country  the  drying  of  fruits  has  been  practiced  since  the  first  coming 
of  white  men.  Dried  apples  and  berries  were  factors  of  much  impor- 
tance in  the  winter  bills-of-fare  of  the  early  colonial  settlers  as  they  had 
been  in  the  winter  supplies  of  the  Indians.  The  methods  of  drying,  how- 
ever, were  crude,  and  in  consequence,  the  dried  product  was  poor  and  by 
no  means  uniform  in  quality. 

Sun-drying. — Sun-drying  of  certain  fruits,  when  carefully  done  under 
favorable  conditions,  is  productive  of  excellent  results.  For  example, 
raisins  and  figs  are  dried  better  in  the  sun  than  by  artificial  methods.  The 
weather,  of  course,  plays  an  important  role.  It  must  be  borne  in  mind, 
however,  that  fruit  is  often  subjected  to  contamination  in  the  open  air. 
It  is  a  matter  of  common  knowledge  that  disease-bearing  micro- 
organisms of  various  kinds,  as  well  as  minute  organisms  which  cause  de- 
cay in  the  fruit,  may  be  carried  in  the  blowing  dust.  Moreover,  insects 
attracted  by  the  fruit  may  deposit  their  eggs  on  it.  Such  possibilities 
can  be  guarded  against,  to  a  large  extent,  by  selecting  clean  and  well- 
protected  out-of-door  drying  places,  by  avoiding  careless  and  unnecessary 
exposure  of  the  fruit,  by  washing  or  sterilizing — in  fact,  by  taking  every 
needful  precaution. 

Artificial  Drying. — During  recent  years  the  methods  of  artificial  dry- 
ing and  the  machinery  employed  for  the  purpose  have  been  so  greatly  im- 
proved that  this  mode  of  preserving  fruit  has  largely  supplanted  the  time- 
hallowed  ways,  in  the  case  of  apples,  apricots  and  peaches,  at  any  rate, 
and  indeed  for  most  of  the  fruits  grown  in  the  northern  parts  of  America 
and  in  Europe.  The  gTcater  cost  of  artificial  methods  is  more  than  offset 
by  the  saving  of  time  and  labor.  The  superiority  of  the  artificially  dried 
product  in  cleanliness  and  uniformity  of  the  fruit  is  so  obvious  as  to  re- 
quire no  emphasis. 

These  improvements,  furthering  the  great  development  of  the  dried- 
fruit  industry  in  the  United  States  in  recent  years,  have  resulted  largely 
from  the  investigations  and  the  efforts  of  the  U.  S.  Department  of  Agri- 
culture and  of  the  agricultural  experimental  stations.  Consequently,  the 
large  fruit-drying  establishments,  numerous  in  the  fruit-growing  sections 
of  this  country,  which  are  distinguished  by  high  standards  of  cleanliness, 
are  reaping  the  reward  of  their  foresight.  The  subject  matter  of  this 
essay  on  dried  fruits  is  partly  gathered  from  a  bulletin  in  the  Year  Book 
of  the  Department  of  Agriculture (9)  and  Farmers'  Bulletin (10)  of  the 
same  department. 


22     peesekvatio:nt  of  foods  by  dehydkation 

The  preparation  of  dried  fruits  for  the  market  involves  a  great  deal 
more  ingenuity  and  thought  than  is  usually  imagined.  It  is  not  a  simple 
matter,  for  although  methods  vary  in  different  districts  and  for  different 
kinds  of  fruits,  they  are  one  and  all  founded  on  a  scientific  basis,  and  as 
Langworthy  aptly  remarks,  "The  producer  who  understands  the  scientific 
reasons  for  all  these  processes  has  the  advantage  of  being  able  to  apply 
them  more  accurately  and  economically,  and  thus  to  get  a  better  and  more 
uniform  product  even  when  crops  and  weather  conditions  are  poor"  (9). 

As  a  rule,  nowadays,  fruits  are  dried  without  the  addition  of  any  for- 
eign substance.  With  regard  to  the  terms  used  to  describe  the  preparation 
of  fruit  products  under  discussion,  the  appellations,  drying,  evaporating, 
desiccating  and  dehydration  are  all  more  or  less  applicable.  We  have  em- 
ployed the  term  dehydration  at  the  head  of  the  chapter,  and  although  there 
may  be  fine  and  nice  distinctions  qualifying  the  exact  significance  of  this 
term,  after  all,  it  is  removal  of  water  which  constitutes  the  principle  of  the 
process.  Dehydration  accurately  means  drawing  off  moisture.  However,  in 
the  case  of  fruits,  "dried  fruit"  is  the  broadest  and  most  appropriate  term. 
The  various  methods  used  have  the  same  object,  the  drying  of  fruits  in 
such  a  way  that  they  shall  retain  as  much  of  the  natural  flavor  and  nutri- 
tive food  properties  as  possible,  and  at  the  same  time  have  an  attractive 
appearance,  be  free  from  contamination  of  any  description,  and,  above  all, 
possess  good  keeping  qualities. 

On  the  whole,  the  modern  methods  of  rapid  drying  produce  fruit 
better  in  flavor,  color  and  texture  than  fruit  dried  at  home  in  the  old- 
fashioned  way.  Some  think  that  a  better  flavor  is  obtained  by  sun  drying, 
but  that  rapid,  artificial  drying  imparts  a  better  color.  The  weight  of  evi- 
dence, however,  for  the  majority  of  the  fruits,  the  most  notable  exceptions 
being  raisins  and  figs,  is  in  favor  of  rapid  artificial  drying. 

The  consumption  of  dried  fruit  in  this  country  is  very  large  and  is 
increasing;  the  exports  also  are  very  important,  showing,  from  all  points 
of  view,  that  the  industry  of  fruit  drying  is  in  a  remarkably  healthy  con- 
dition. California  easily  leads  in  the  production  of  dried  fruits.  More 
than  80  per  cent  of  the  total  amount  comes  from  that  state.  The  present 
output  of  dried  fruits  in  this  country  is  in  excess  of  500,000,000  pounds 
annually. 

Dried  Prunes — Up  to  quite  recent  times  apples  were  the  chief  fruit 
dried  in  this  country.  Recently,  however,  while  the  quantity  of  apples 
so  treated  increases  slowly,  the  drying  of  raisins,  prunes  and  peaches  pro- 
gresses by  leaps  and  bounds.  As  long  ago  as  1909,  statistics  showed  that 
about  12,000,000  pounds  of  dried  apricots,  44,000,000  pounds  of  dried 


APPLICATION    OF    I^EIIYDKATION    TO    FOODS         23 

peaches  and  11^,000,000  pounds  of  prunes  were  consumed  in  Amer- 
ica alone.  More  and  more  of  these  fruits  are  being  dried  each  year. 
Prunes,  peaches,  apricots  and  cherries,  belonging  to  the  same  botanical 
family,  are  subjected  to  much  the  same  kind  of  process,  so  that  a  descrip- 
tion of  the  methods  used  for  drying  prunes  will  exemplify  the  manner 
in  which  similar  fruits  are  dried. 

PREPARATION  OF  FRUIT  FOR  DEHYDRATION.— It  is  needless  to  ex- 
plain that  prunes  are  dried  plums.  Everyone,  however,  does  not  know 
that  American  California  and  Oregon  plums,  in  particular,  are  fast  taking 
the  lead  as  the  main  sources  of  prune  products.  In  order  to  have  the  fin- 
ished product  in  the  very  best  condition,  the  greatest  care  must  be  taken 
not  only  in  the  carrying  out  of  the  process  itself,  but  in  the  prior  prepara- 
tion of  the  fruit.  In  the  first  plat.'C,  the  gathering  should  be  done  most 
carefully,  the  fruit  should  be  picked  by  hand  or  shaken  gently  upon  sheets 
spread  under  the  trees,  the  object,  of  course,  being  not  to  bruise  them.  If 
the  plums  be  not  perfectly  ripe,  they  should  be  exposed  to  the  rays  of  the 
sun  for  a  day  or  two,  so  that  their  natural  sugar  content  may  be  increased 
and  their  water  content  diminished.  1'he  fruit  is  then  graded  according 
to  size  to  render  the  drying  more  uniform.  Cleaning  the  fruit  is  the  next 
step,  followed  by  treatment  of  the  skin  in  such  a  way  that  the  water  will 
be  all  the  more  quickly  evaporated  from  the  interior.  Dipping  the  fruit 
in  boiling  water  is  sometimes  thought  to  sufficiently  answer  the  purpose ; 
but  more  frequently  this  simple  method  is  supplemented  by  pricking  the 
skins  with  a  special  apparatus,  by  dipping  the  fruit  into  lye,  or  by  placing 
the  sorted  prunes  into  perforated  metal  baskets  which  are  dipped  into  a 
hot  0.75  per  cent  solution  of  potash.  The  fruit  is  only  kept  in  this  solution 
a  very  short  time,  just  dipped  in  and  out,  and  immediately  transferred 
to  cold  water.  This  is  necessary  to  prevent  the  prunes  from  acquiring  an 
alkaline  taste.  The  alkaline  bath  removes  the  thin  coating  of  wax,  the 
so-called  bloom,  which  would  interfere  with  the  passage  of  the  water 
through  the  skin  when  the  drying  process  is  in  progress.  California  prune 
dryers  use  a  soda  in  preference  to  a  potash  solution.  Having  expedited 
the  evaporation  of  water  from  the  interior,  and  having  washed  the  alkali 
free,  the  fruit  is  ready  for  drying. 

When  the  climate  is  suitable,  and  the  weather  permits,  prunes  are 
sometimes  dried  in  the  open  air,  or  in  ordinary  drying  sheds,  but  most 
frequently  artificial  means  are  resorted  to,  to  hasten  the  process. 

As  said  before,  the  question  of  the  best  and  most  rational  method  of 
preparing  dried  fruit  cannot  be  answered  offliand  or  in  general  terms. 
Local  conditions  largely  determine  this  matter ;  the  amount  and  the  kind 


24      PEESERVATION    OF   FOODS    BY   DEHYDRATION 

of  raw  materials  available  are  the  most  important  factors  involved.  Sun- 
drying  in  California  usually  requires  from  one  to  two  weeks,  and  artifi- 
cial drying  a  considerably  shorter  period  of  time — the  ordinary  American 
method  requiring  from  twenty-four  to  forty-eight  hours,  according  to  the 
character  of  the  fruit. 

METHODS  OF  DEHYDRATION.— At  the  present  time  there  are  three 
principal  systems  used  by  those  engaged  in  the  fruit-evaporating  industry : 
first,  the  old  method  of  drying  in  a  hot  chamber  under  ordinary  atmos- 
pheric conditions ;  second,  the  vacuum  system,  by  which  the  fruit  is  dried 
under  diminished  atmospheric  pressure;  and  third,  the  dehydrating  sys- 
tem, in  which  the  fruit  is  dried  by  warm  air  which  has  been  previously 
cooled  at  a  low  temperature  so  as  to  deprive  it  of  the  moisture  which  it 
might  contain.  The  advantages  claimed  for  this  latter  system  are  that  the 
fruit  can  be  dried  at  a  much  lower  temperature  than  is  possible  otherwise, 
because  the  air  being  quite  dry,  can  take  up  large  quantities  of  moisture 
without  requiring  to  be  heated.  It  is  also  more  rapid  than  the  other  proc- 
esses. As  stated  in  the  remarks  on  the  dehydration  of  vegetables,  this 
method  does  not  injure  the  cellular  structure  and  consequently  vegetables 
and  fruits  treated  by  this  method  retain  to  a  remarkable  degree  their  con- 
tour and  full  flavor  when  prepared  for  the  table. 

Dried  prunes  are  "sweated"  for  two  or  three  weeks  and  then  regraded 
according  to  the  number  required  to  make  a  pound.  After  grading  they 
are  finished  or  "glossed"  by  heating  in  steam  or  immersing  in  salted  boil- 
ing water,  fruit  juice  or  glycerin,  by  which  means  the  exterior  is  sterilized 
and  a  shiny  surface  is  imparted. 

Dried  Peaches  and  Apricots — Peaches  and  apricots  are  usually  pitted 
before  drying.  After  using  the  same  care  in  gathering  these  fruits  as  in 
the  case  of  plums,  in  order  to  avoid  bruising,  they  are  then  promptly 
prepared  for  drying.  "When  peaches  are  peeled  before  drying,  they  are 
usually  dipped  in  hot  lye  to  loosen  the  skin,  but  apricots  are  almost  in- 
variably dried  with  their  skins  on.  When  the  fruit  has  been  pitted  and 
cut,  it  is  laid  in  trays.  When  siilphuring  is  practiced,  a  method  which 
will  be  described  briefly  when  the  evaporation  of  apples  is  discussed,  it 
takes  place  at  this  point.     The  drying  proper  then  follows. 

OLD-FASHIONED  METHOD  OF  DRYING  FRUIT.— The  following  house- 
hold method  of  drying  peaches  and  plums,  which  was  prevalent  in  the  old 
days,  is  still  practiced  in  the  Southeastern  States.  The  fruit  is  peeled, 
pitted,  mashed,  spread  out  in  a  thin  layer,  and  dried  in  an  oven  or  in  the 
sun  until  the  mass  is  tough  and  resembles  leather  in  appearance.  The 
name  given  to  it  is  peach  or  plum  leather,  and  it  is  said  to  keep  indefi- 


APPLICATION   or   DEHYDRATION    TO    POODS         25 

nitely,  even  if  only  packed  in  bags.  Stone  fruits  are  sometimes  preserved 
by  housekeepers.  The  fruit  is  pitted,  sprinkled  with  sugar,  placed  in  an 
oven  moderately  heated,  kept  there  until  the  oven  is  hot  and  afterwards 
dried  slowly  in  the  sun  or  in  a  cool  oven. 

Dried  Apples — Apples  have  been  artificially  dried  in  this  country,  at 
least,  on  a  large  scale  for  a  longer  period  than  any  other  fruit.  A  large 
quantity  of  apples  is  still  dried  in  primitive  fashion.  In  country  districts 
in  which  apple  cultivation  is  not  carried  on  extensively,  there  is  frequently 
to  be  seen  during  the  autumn,  apples  sliced  or  quartered  for  drying  in 
the  sun,  placed  on  a  flat  rock,  on  the  roof  of  a  low  shed  or  on  any  easily 
available  flat  surface.  While,  perhaps,  the  greater  part  of  this  sun-dried 
fruit  is  intended  for  home  consumption,  a  good  deal  of  it  is  sent  to  the 
market  and  some  is  exported. 

According  to  H.  P.  Gould,  the  average  weight  of  ripe  winter  apples 
of  mixed  varieties  is  about  fifty  pounds  to  the  bushel.  In  evaporating 
them  some  forty  pounds  of  water  per  bushel,  or  approximately  five  gallons, 
passes  off  in  the  form  of  vapor.  The  object  of  the  process  is  to  draw  off, 
as  rapidly  as  possible  by  artificial  means,  sufficient  moisture  to  prevent 
deterioration  through  decay  or  other  natural  means,  and  at  the  same  time 
to  maintain  a  desirable  texture  and  flavor. 

More  apples  are  artificially  dried  than  any  other  fruits,  because  they 
are  grown  more  largely  in  temperate  climates.  In  many  of  the  lands 
in  which  apples  flourish,  the  changeableness  of  the  weather  renders  sun 
drying  out  of  the  question,  hence  evaporators  are  numerous.  Some  are 
situated  in  villages  near  railroad  stations  or  in  a  central  and  easily 
reached  locality.  Many  are  erected  in  or  about  the  orchards  them- 
selves. The  largest  evaporators,  generally  placed  in  towns  or  villages, 
are  operated  by  men  who  make  a  business  of  evaporating;  consequently 
these  plants  are  of  larger  capacity  and  are  better  constructed  in  every 
respect  than  those  in  the  orchards. 

It  would  be  superfluous  to  enter  here  into  a  detailed  description  of  the 
various  kinds  of  evaporators  in  use.  The  brief  description  given  a  few 
pages  back  of  the  three  chief  systems  for  dehydrating  fruits  will  suffice. 

Dried  apples  are  produced  on  a  large  scale,  in  three  principal  forms : 
whole  apples,  consisting  of  the  smaller  fruits  which  have  been  peeled  and 
the  core  removed ;  split  apples,  made  from  larger  fruit  which  have  been 
peeled,  the  seeds  removed,  and  the  fruit  split  lengthwise  in  six  or  eight 
sections,  and  "ring  apples,"  made  from  large  fruit,  which  after  peeling 
and  removing  of  tlie  core,  are  cut  across  the  core  hole  into  thin  flat 
disks. 


26      PRESERVATION    OF    FOODS   BY    DEHYDRATION 

It  must  always  be  borne  in  mind  that  the  success  of  the  process  of 
drying  apples  depends  mainly  on  the  kind  of  fruit  used.  Of  course,  the 
primary  economy  of  evaporating  fruits  is  in  utilizing  the  surplus  fruit  and 
poorer  grades  of  fruits,  which  would  otherwise  be  wasted.  Consequently, 
it  is  this  sort  of  fruit  which  is  usually  dried.  Nowadays,  however,  there 
is  an  increasing  demand  for  dehydrated  apples  of  the  best  quality. 

An  important  point  which  is  often  overlooked  in  the  selection  of  apples 
for  drying,  is  the  fact  that  the  varieties  of  apples  differ  considerably  in 
the  amount  of  substance  they  lose  in  peeling  and  coring,  and  in  the  weight 
of  dried  fruit  they  will  give.  Water  constitutes  the  greater  part  of  the 
weight  of  an  apple.  Some  kinds  of  apples  contain  more  water  than  others, 
and  the  water  content  of  the  same  variety  of  apples  will  vary,  in  some 
degree,  according  to  the  season  and  weather. 

Complicated  machines  which  peel,  core  and  sometimes  even  slice  the 
apple  at  one  operation  are  in  general  use.  After  these  operations  are  com- 
pleted, the  apples  are  as  a  rule  dipped  for  a  few  minutes  in  a  weak  solu- 
tion of  salt  and  water  to  prevent  the  discoloration  brought  about  in  several 
varieties  of  apples  by  the  action  of  the  oxygen  in  the  air.  The  fumes  of 
burning  sulphur  are  employed  not  only  to  achieve  the  same  object,  but 
to  prevent  further  discoloration  after  the  apple  has  been  sliced,  and  to 
render  the  color  lighter.  The  method  is  also  supposed  to  be  necessary  to 
kill  moths,  insects,  fungi  or  hurtful  microorganisms.  Bleaching  by  sul- 
phur should  be  employed  immediately  after  the  surface  of  the  apple  has 
been  exposed  to  the  air  by  paring.  On  being  removed  from  the  dehydrator 
the  fruit  should  be  allowed  to  stand  for  the  "sweating"  to  take  place,  a 
process  which  generally  lasts  for  several  days  and  which  should  be  carried 
out  in  the  open  air.  or  in  w^ell-ventilated  rooms. 

The  proper  storage  of  the  dried  fruit  is  important  because  if  brought 
into  a  damp  atmosphere  the  spongy  cells  will  absorb  additional  moisture 
which  may  accumulate  to  such  an  extent  as  to  again  make  the  fruit  a 
favorable  medium  for  the  growth  of  bacteria. 

Raisins. — The  amount  of  raisins  produced  in  this  country  is  enormous. 
The  methods  of  curing  the  grapes  depend  partly  upon  the  purpose  for 
which  the  dried  products  are  intended.  The  smaller  varieties  of  grapes 
are  used  for  making  raisins  for  cooking  purposes,  and  only  the  best  quality 
of  the  larger  varieties  can  be  dehydrated  to  make  good  table  or  layer 
raisins.  Bunches  of  the  latter  are  first  carefully  picked  over,  and  the 
dried  or  unripe  fruit  discarded.  The  bunches  are  then  placed  on  trays 
in  the  sun.  The  smaller  sultana,  the  currant  varieties  and  the  less  attrac- 
tive bunches  of  grapes  of  the  larger  varieties  are  dipped  in  weak  lye  before 


APPLICATION    OF    DEHYDRATION    TO    FOODS         27 

they  are  dried  in  order  to  soften  the  skins  slightly  and  loosen  the  stems 
which  are  removed  before  the  raisins  are  packed. 

Other  Dried  Fruits. — In  days  gone  by,  strawberries,  raspberries,  black- 
berries, blueberries,  barberries,  currants  and  most  small  native  fruits  were 
frequently  dried  at  home.  This  practice  has  greatly  fallen  into  disuse 
since  dehydration  and  preserving  have  come  into  vogue,  but  still  exists  in 
a  few  regions,  notably  in  the  mountains  of  Tennessee,  where  dietary 
studies  made  by  the  Department  of  Agriculture  showed  that  these  dried 
berries  were  used  as  staple  foods. 

Dates  are  cured  in  this  country,  the  date  palm  having  been  introduced 
and  found  to  ripen  well  in  Arizona  and  neighboring  regions,  but  as  yet 
the  industry  is  in  its  infancy. 

While  the  fig  tree  can  be  gTown  in  any  mild  climate,  the  varieties  suit- 
able for  drying  can  be  produced  only  under  special  conditions.  However, 
most  of  the  difficulties  in  this  direction  have  been  overcome.  In  Cali- 
fornia, the  Smyrna  fig  has  become  naturalized,  and  the  dry  fig  industry  in 
that  state  is  assuming  goodly  proportions. 

Bananas — The  banana  is  not  dried  in  this  country,  but  as  it  is 
regarded  from  nearly  all  standpoints  as  the  most  nutritive  of  fruits,  it  will 
be  pertinent  to  deal  somewhat  briefly  with  the  drying  of  bananas.  Ja- 
maica has  been,  so  to  speak,  the  mother  of  the  dried  banana  industry,  and 
it  is  on  this  island  that  the  majority  of  the  really  important  factories  for 
drying  bananas  are  now  to  be  found.  There  are  several  factories  for  the 
same  purpose  in  the  Philippines.  The  drying  of  bananas  is  done  by  hot 
air.  The  larger  pieces  of  dried  banana  are  generally  known  as  "banana 
figs." 

j:)K1ED  banana  products.— The  dried  food  products  made  from 
bananas  are  "banana  figs,"  cooking  bananas,  banana  chips  and  banana 
flour  and  meal.  All  the  factories  in  Jamaica  dry  or  evaporate  the  bananas 
whole  without  the  addition  of  sugar,  and  yet  they  are  as  sweet  and  pal- 
atable as  pressed  figs.  Cooking  bananas  are  so  thoroughly  dried  as  to  be 
quite  hard.  Their  color  is  almost  white.  Wlien  broken  into  pieces,  they 
are  knowni  as  banana  chips  and  are  exported  to  be  ground  into  meal  or 
flour.  All  banana  foods  are  wholesome  and  nutritious,  and,  owing  to  the 
large  yield  of  the  fruit  and  its  high  carbohydrate  content  of  sugar  and 
starch,  bananas  have  long  been  recognized  as  a  very  cheap  food,  although 
their  value  from  the  nutritive  and  economic  standpoints  is  not  yet  fully 
appreciated.  "Banana  figs"  are  delicious,  and  cut  into  small  pieces  may 
be  used  like  raisins  to  impart  an  additional  flavor  to  cakes  and  puddings. 
The  chips  after  having  been  well  pounded  or  ground  in  a  coffee  or  other 


28       PRESEKVATIOX    OF    FOODS    BY    DEHYDRATION 

hand  mill,  may  be  boiled  and  then  used  as  an  excellent  breakfast  food  or 
for  making  puddings.  Gruel,  porridge  or  other  preparations  made  from 
banana  meal  or  flour,  which  is  rich  in  easily  soluble  carbohydrates,  are 
recommended  for  infants,  invalids  and  dyspeptics.  It  is  said  that  the 
negro  women  of  Jamaica  use  banana  meal  gruel  as  a  substitute  for  milk 
for  their  infant  children.  An  inexpensive  and  nutritious  bread  can  be 
made  from  banana  flour,  or  the  flour  may  be  admixed  with  other  ingredi- 
ents to  make  a  wholesome  and  cheap  bread. 

Unusual  Dried  Fruits — The  better  qualities  of  the  meat  in  the  interior 
of  the  cocoanut  seed,  commonly  known  as  copra,  is  desiccated.  It  is  used 
mainly  for  flavoring  and  garnishing  purposes  in  the  countries  into  which 
it  is  exported.  There  are  several  other  dried  fruits,  some  of  which  are 
grown  and  dried  here,  but  most  of  which  are  imported.  Among  these  the 
following  may  be  mentioned:  olives  from  the  eastern  Mediterranean  re- 
gion, where  they  are  eaten  as  a  staple  food;  dried  cactus  fruit,  in  the 
southwestern  part  of  this  country,  in  Mexico  and  in  lands  abutting  on  the 
Mediterranean;  and  dried  chestnut,  much  used  in  European  cookery  and 
now  fairly  prevalent  in  America.  In  China  may  be  found  the  lichi  nut 
or  Chinese  raisin.  The  jujube  is  common  in  China  and  Japan,  but  is  lit- 
tle known  here  except  in  the  form  of  jujube  paste.  There  is  also  the  carob 
bean  or  St.  John's  bread,  the  dried  pods  of  a  European  locust  bean. 

Of  Chinese  and  Japanese  fruits  available  for  drying,  the  persimmon 
is  the  most  suitable.  In  some  districts  of  China  strains  of  persimmon  are 
found  which  are  being  grown  for  drying  purposes  only.  A  dried  persim- 
mon in  appearance  and  flavor  resembles  a  dried  fig  with  the  exception 
that  it  is  devoid  of  small  seeds,  and  is  covered  with  a  heavy  layer  of  fine 
grape  sugar.  The  cultivation  of  persimmons  for  drying  purposes  is  a 
growing  industry  in  China,  where  thousands  of  acres  are  devoted  to  this 
purpose.  Hundreds  of  varieties  exist,  and  the  trade  in  China  of  dried  per- 
simmons compares  in  importance  with  our  trade  in  dried  peaches. 

Comparison  of  Food  Value  of  Fresh  and  Dried  Fruits — The  food  value  of 
dried  fruits  is  naturally  their  most  important  characteristic,  although  a 
pleasing  flavor  is  an  extremely  desirable  adjunct,  as  is  also  their  acid  con- 
tent, which  is  believed  to  aid  digastion.  The  flavor,  the  aroma  and  the 
appearance  act  as  stimulants  to  appetite  and,  according  to  present-day 
views,  influence  the  secretion  of  the  gastric  juices. 

The  flavor  of  dried  fruits  is  seldom  if  ever  the  same  as  that  of  fresh 
fruits,  but  as  mentioned  before,  fruits  dehydrated  by  the  most  recent 
American  process  retain  to  a  very  considerable  degree  their  fresh  taste 
and  flavor. 


APPLICATION    OF    DEHYDEATION    TO    FOODS 


29 


A  pound  of  fresh  fruit  will  yield  on  an  average  about  six  ounces  dried. 
The  food  value  then  of  one  pound  of  dried  fruit  is  greater  than  that  of 
the  same  weight  of  fresh,  since  it  has  been  concentrated  by  evaporating 
the  original  water  content. 

It  goes  without  saying  that  the  nutritive  value  of  dried  fruits,  as  of 
other  foods,  in  the  first  instance,  depends  upon  the  proportion  of  food  in- 
gredients therein  contained,  and  in  a  general  way  the  food  value  is  in 
inverse  ratio  to  the  water  content.  Analysis  has  demonstrated  that  dried 
fruits  which  contain  from  15  to  30  per  cent  water — and  by  the  most  mod- 
ern methods  of  dehydration  a  good  deal  less  water  remains — are  relatively 
so  much  the  more  nutritious  than  fresh  fruits,  of  which  the  water  contents 
average  anywhere  from  75  to  95  per  cent. 

Tlie  following  table  will  show  the  average  composition  of  dried  fruits 
and  fruit  products : 

ANALYSIS  AND  CALORIC  VALUE  OF  DRIED  FRUITS   (PER  POUND) 


Refuse, 
per  cent 

Water, 
per  cent 

Pro- 
tein, 
per  cent 

After 
extract, 
per  cent 

Edible  Portion 

Fruits 

Nitro- 
gen free 
extract, 
per  cent 

Crude 

fiber, 

per  cent 

Ash, 
per  cent 

Fuel 
value 

per 
pound 

Apples 

10.0 

15.0 
10.0 

26.1 
29.4 
29.2 

9.7 
19.0 
15.4 
18.8 
16.5 
22.3 
14.6 

8.1 
17.3 
17.2 

1.6 
4.7 
5.3 
3.1 
.5 
2.1 
4.3 
2.8 
2.1 
2.6 
7.3 
5.7 
2.4 

2.2 

1.0 

2.3 

.5 

1.5 

2.8 

.3 

5.4 

3.3 
1.8 
1.1 
1.7 

62.0 
62.5 
55.5 
83.4 

78.1 
74.6 
68.0 
66.0 
71.2 
73.6 
80.2 
67.0 
71.2 

6.1 

2.1 

.7 

3.5 

6.2 
6.9 
2.1 
2.5 

6.4 
3.0 

2.0 
2.4 
5.3 
2.6 
.9 
1.3 
2.4 
2.4 
2.3 
3.4 
2.6 
2.5 
4.5 

1,350 

Apricots      .... 

1,290 

Bananas 

1,240 

Banana  flour .... 
Citrons 

1,610 
1,525 

Dates 

1,615 

Figs 

1,475 

Pears 

1,635 

Prunes 

1,400 

Raisins 

1,605 

Raspberries 

St.  John's  bread. . 
Zante  currants. . . 

1,705 
1.480 
i;495 

The  fuel  value  per  pound  of  fresh  apples  is  only  290  calories ;  of  apri- 
cots, 270 ;  of  bananas,  460 ;  of  raspberries,  255,  and  so  on. 

While  the  main  change  that  takes  place  during  the  dehydration  of 
fruit  is  the  loss  of  water,  other  changes  likewise  occur,  varying  with  the 
kinds  of  fruits  and  the  methods  employed.  In  dried  fruits,  the  fact  must 
be  taken  into  consideration  that  in  contradistinction  to  fresh  fruits,  the 
refuse  is  reduced  to  a  minimum.  Moreover,  of  the  small  acid  content 
found  in  fresh  fruits,  as  apples,  pears,  plums,  berries,  etc.,  the  gi*eater  part 
remains  in  the  dried  fruits.     It  has  been  stated  previously  that  the  food 


30      PEESEPtVATIOi^    OF    FOODS    BY    DEHYDRATION 

value  of  such  fruits  is  higher  the  lower  the  water  content.  Consequently, 
raisins,  dates  and  figs  having  on  the  whole  a  less  water  content  than  dried 
apples,  peaches  and  prunes,  contain  more  nutritive  material.  The  food 
value  of  fruits,  as  of  vegetables,  depends  chiefly  on  the  carbohydrates  they 
contain  in  the  form  of  sugar.  Protein  is  so  little  in  evidence  in  fruits  as 
to  be  practically  a  negligible  quantity.  Fats,  too,  need  not  be  taken  into 
account.  The  mineral  constituents  of  fruits  occur  in  all  varieties  and  are 
important  in  that  they  are  necessary  for  the  formation  of  the  fluids  and 
tissues  of  the  body. 

As  sources  of  nutrition,  and  more  especially  of  energy,  dried  fruits 
compare  rather  with  cereals  and  dry  vegetable  foods  than  with  fresh  fruits. 
In  many  respects  they  even  compare  favorably  with  the  former,  although 
it  should  not  be  forgotten  that  they  yield  less  protein  than  cereals  and 
legumes  and  only  extremely  small  quantities  of  fat.  However,  dehydrated 
fruits,  some  more  than  others,  retain  a  certain  amount  of  the  properties 
of  fresh  fruits.  For  instance,  many  fruits  have  a  laxative  action — indeed 
they  are  often  eaten  for  this  very  purpose,  and  the  efl^ect  appears  to  be 
equally  as  potent  with  dried  as  with  fresh  fruits.  The  manner  of  de- 
hydrating by  the  most  advanced  American  methods  seems  to  be  not  only 
effective  in  conserving  fruits,  but,  to  a  large  extent,  in  preserving  their 
original  properties. 

Economic  Advantages  of  Dried  Fruit. — The  economy  of  dehydrating 
fruit  can  be  conclusively  proven  without  the  least  difficulty.  It  is  obvious 
that  dehydrated  fruit  is  economical  because  it  has  a  higher  food  value  than 
fresh  fruit,  and  because  of  the  ease  by  which  it  can  be  transported,  on  ac- 
count of  its  keeping  properties  and  its  small  bulk,  thus  preventing  the  sac- 
rifice of  surplus  supply  or  fruit  of  inferior  quality.  But  from  the  point 
of  view  of  cost,  dehydrated  fruits  are  economical.  Even  now  these  fruits 
may  be  termed  reasonable  in  price  compared  with  many  other  ordinary 
articles  of  diet.  This  has  been  demonstrated  by  a  large  number  of  studies 
made  in  connection  with  the  nutrition  investigations  of  the  Office  of  Ex- 
periment of  the  U.  S.  Department  of  Agriculture.  From  these  studies, 
and  from  information  derived  from  other  sources,  these  conclusions  may 
be  with  fairness  drawn.  Since  all  the  fruit  products  contain  little  pro- 
tein, they  are  more  expensive  by  far  than  the  cereals  and  dried  legumes 
and  most  animal  foods.  On  the  other  hand,  as  sources  of  energy,  derived 
almost  wholly  from  their  sugars  and  other  carbohydrate  contents,  de- 
hydrated fruits  are  a  great  deal  cheaper  than  meats,  compare  favorably 
with  dairy  products,  but  are  more  expensive  than  cereals  and  starchy 
vegetables,  as  dried  beans  or  potatoes. 


APPLICATION^    OF    DEHYDRATION    TO    FOODS 


31 


So  far  as  a  coinparisou  of  one  dehydrated  fruit  with  another  is  con- 
cerned, that  is  as  regards  its  food  value,  the  cheaper  compare  favorably 
with  the  more  expensive  kinds. 

The  following  table  will  show  the  comparative  cost  of  total  nutrients 
and  energy  in  some  fresh  and  dried  fruits  and  other  food  materials  at  cer- 
tain average  prices  in  1907.  Since  that  time  prices  have  advanced  con- 
siderably, but  the  comparison  will  still  hold  good,  except,  perhaps,  that  the 
price  of  meat  will  be  relatively  higher  at  the  present  time  than  that  of 
dried  fruit. 

COMPARATIVE  COST  OF  TOTAL  NUTRIENTS  AND  FUEL  VALUE 
OF  SOME  FRESH  AND  DRIED  FRUITS 


Kind  of  Food 
Material 


Price 

per 

Pound 


Cost  of 
1  pound 
Protein 


Cost  of 

1,000 

Calories 

Energy- 


Total 
Weight 
of  Food 
material 


Amounts  for  Ten  Cents 


Protein 


Fat 


Carbo- 
hydrate 


Energy 


Fresh  fruits: 

Apples 

Plums 

Grapes 

Dried  fruits: 

Apples 

Dates 

Figs 

Prunes 

Raisins 

Porterhouse  steak 

Whole  milk 

Skim  milk 

White  bread 

Sugar 

Dried  beans 


Cents 

1.5 
3.0 
4.0 

12.0 

10.0 

15.0 

10.0 

10.0 

25.0 

3.5 

2.0 

5.0 

6.0 

5.0 


Dollars 

5.00 
3.33 
4.00 

7.50 
5.26 
3.50 
5.56 
4.35 
1.31 
1.06 
,59 
.54 

.22 


Cents 

7.3 

8.1 

11.9 

8.9 

6.9 

10.2 

8.4 

6.9 

22.5 

10.5 

11.8 

4.2 

3.2 

3.1 


Lbs. 

6.67 
3.33 
2.50 

.83 
1.00 

.67 
1.00 
1.00 

.40 
2.86 
5.00 
2.00 
1.67 
2.00 


Lbs. 

.02 
.03 
.03 

.01 
.02 
.03 
.02 
.02 
.07 
.09 
.17 
.18 

.45 


Lbs. 

.02 

.03 

.02 
.03 


.03 
.07 
.11 
.02 
.03 

.03 


Lbs. 

.72 
.64 
.36 

.55 
.71 
.50 
.62 
.69 

.14 

.26 

1.06 

1.67 

1.19 


Calories 

1,467 

1,232 

837 

1,121 

1,450 

988 

1,190 

1,445 

444 

925 

850 

2,430 

3,106 

3,210 


From  a  broad  outlook,  it  appears  plainly  evident  that  dried  fruits  are 
the  cheapest  of  the  fruit  products  and  the  most  economical.  Neither  fresh 
nor  dried  fruits  can  be  rightly  regarded  as  a  luxury,  since  they  add  con- 
siderably to  the  food  value  of  a  diet,  and  vary  the  monotony  of  the  daily 
fare.  Dried  fruits  in  sealed  cartons  or  packages  are  much  safer  because 
they  are  less  easily  soiled  than  when  sold  in  open  boxes.  There  is  little 
doubt  that  the  fruit  products  dehydrated  by  the  most  up-to-date  American 
processes  are  cleaner  by  far  and  better  in  every  respect  than  those  sub- 
jected to  the  old-fashioned  methods  and  are  superior  to  the  imported 
varieties. 


32      PRESERVATION    OF    FOODS    BY    DEHYDRATION 

DEHYDRATED    VEGETABLES 

Dehydration  is  absolutely  the  correct  term  to  apply  to  the  process  used 
for  preserving  vegetables  by  withdrawing  the  moisture  which  has  been  de- 
veloped and  it  may  almost  be  said  perfected  in  this  country. 

Importance  of  Dehydrated  Vegetables  as  Food In  the  introduction  to 

this  chapter,  stress  was  laid  with  intent  upon  the  supreme  importance  of 
dehydrating  vegetable  foodstuffs  in  such  a  manner  that  when  prepared  for 
feeding  purposes  they  resemble  in  all  their  salient  and  essential  features 
these  same  vegetables  in  their  original  form.  It  was  pointed  out  that 
vegetables  thus  treated  furnished  an  economical  advance  of  immeasurable 
value,  since  vegetables  far  more  than  fruits  provide  all  the  forms  of  nutri- 
tive material  necessary  to  maintain  the  human  organism  at  a  high  stand- 
ard of  health.  Some  vegetables  from  their  protein  content  are  fairly  sat- 
isfactory substitutes  for  meat ;  others  are  valuable  as  foods  because  of  their 
carbohydrate  and  fat  content.  In  order  to  make  up  a  well-balanced  dietary 
and  to  avoid  constipation,  that  bane  of  this  age,  the  consumption  of  a  cer- 
tain amount  of  vegetables  is  always  indicated. 

It  is  difficult,  even  frequently  impossible,  except  at  prohibitive  prices, 
to  procure  really  fresh  vegetables  at  all  times  of  the  year.  It  is  true  that 
one  can  always  buy  canned  vegetables,  but  canned  goods  have  their  draw- 
backs. Dehydrated  vegetables,  when  properly  prepared,  retain  their  orig- 
inal flavor  in  a  far  higher  degree  than  the  ordinary  canned  vegetables  and 
cereals ;  a  few  vegetables  are  improved  in  flavor  by  dehydration.  The  pre- 
dominating advantages  of  this  process  lie  not  only  in  the  facility  and  cer- 
tainty with  which  vegetables  and  cereals  can  be  preserved  for  a  great 
length  of  time  without  any  clearly  perceptible  loss  of  taste,  flavor  or  nutri- 
tive properties,  but  in  the  ease  with  which  they  can  be  transported  owing 
to  their  small  bulk. 

Methods  of  Dehydrating  Vegetables — ^It  may  be  stated  emphatically 
that  no  single  device  for  the  preservation  of  foodstuff  excels  that  of  de- 
hydration. Apart  from  the  element  of  cost,  the  use  of  an  extreme  degree 
of  heat  to  drive  out  moisture  has  the  objection  that  in  some  cases  it  so 
alters  the  product  that  it  is  no  longer  an  agreeable  article  of  diet.  Heat 
also  removes  desirable  volatile  ingredients.  It  may  be  pointed  out  that 
flavors,  which  play  a  very  important  part  in  rendering  a  food  palatable 
and  acceptable,  are,  as  Mendel  shows,  not  always  thermostabile. 

The  most  destructive  criticism  that  can  be  brought  against  the  use 
of  heat,  particularly  at  high  temperatures,  as  a  mode  of  drying  food- 
stuffs is  that  high  temperatures  for  a  prolonged  period  are  liable  to 


APPLICATION    OF    DEHYDRATION    TO    FOODS         33 

seriously  injure  the  vitamine  element.  The  presence  or  absence  of  this 
element,  in  fact,  when  a  diet  is  restricted  to  one  or  two  food  materials, 
makes  all  the  diiference  between  health  and  disease.  Therefore  it  would 
seem  to  be  the  bounden  duty  of  those  engaged  in  the  dehydrated  food 
industry  to  take  every  precaution  not  to  destroy  or  injure  these  "accessory 
diet  factors"  known  as  vitamines.  It  is  stated  by  those  who  have  had 
experience  with  the  American  process  of  dehydration  that  becavise  the 
heat  employed  is  not  intense,  and  because  the  time  during  which  the 
food  material  is  subjected  to  the  process  is  not  long,  that  the  vitam- 
ine substances  are  in  no  wise  prejudicially  affected.  The  main  dehy- 
drating characteristics  of  the  system  are  the  comparatively  low  tempera- 
ture which  insures  the  retention  of  all  the  valuable  properties  of  the  food 
treated  and  the  thorough  circulation  of  the  air  currents  which  permeate 
vegetables  or  fruits  in  such  a  way  that  most  eifective  dehydration  is  the 
result. 

Enough  has  been  said  as  to  the  system  of  dehydration  best  calculated 
to  fulfill  the  purpose  desired,  and  the  only  excuse  for  being  somewhat 
prolix  about  the  matter  is  that  the  success  of  a  dehydrating  method 
depends  entirely  upon  its  mode  of  working.  If  the  finished  product,  to 
use  a  rather  clumsy  expression,  is  not  as  nutritive,  palatable  and  attractive 
in  appearance  when  prepared  for  the  table  as  the  vegetable  in  its  original 
form,  or  nearly  so,  then  its  other  obvious  advantages — small  bulk  and 
keeping  properties — cannot  compensate  for  this  lack. 

Dehydrated  Potatoes — The  potato  is,  of  all  the  vegetables,  the  most 
important.  Of  the  starchy  group  the  common  potato  easily  occupies  the 
first  place,  both  in  regard  to  nutritive  value  and  to  the  wide  range  of  its 
cultivation.  In  this  country  the  sweet  potato  comes  next  in  popularity, 
usefulness  and  consumption.  In  1909(11)  it  was  shown  that  in  the 
average  of  376  American  dietary  studies,  potatoes  were  found  to  furnish 
12,5  per  cent,  or  about  one-eighth,  of  the  total  food  material,  and  8.3  per 
cent,  or  about  one-twelfth,  of  the  carbohydrates.  All  other  vegetables 
together  furnished  only  Y.8  per  cent  of  the  total  food  and  3.7  of  the  carbo- 
hydrates. The  structure,  composition  and  nutritive  properties  of  the 
potato  have  been  exhaustively  dealt  with  in  Volume  I,  Chapter  XIII, 
therefore  it  will  be  superfluous  to  discuss  this  phase  of  the  question 
further.  Attention  will  now  be  concentrated  upon  a  consideration  of 
dehydrated  potatoes,  their  virtues  and  drawbacks. 

METHODS  OF  DEHYDRATION— It  may  be  well  imagined  that  efforts 
have  been  made  to  preserve,  in  a  compact  form,  a  food  substance  of  so 
great  value  in  the  diet  as  is  the  potato.     This  object  has  been  brought 


34      PKESEKVATIOX    OF    FOODS    BY    DEHYDRATION 

about  by  drying,  which  reduces  their  bulk  and  prevents  decay.  The 
word  drying  is  used  here  intentionally,  because  dehydration  is  a  recent 
method,  and  potatoes  have  been  dried  in  various  ways  for  a  gi-eat  num- 
ber of  years.  The  method  known  as  "chunno"  is  one  of  the  oldest  and 
has  been  employed  in  Peru  for  a  very  long  time.  This  procedure  consists 
of  pressing  part  of  the  juice  out  of  the  potatoes,  which  are  then  dried  in 
the  air  until  they  are  reduced  to  about  one-fourth  of  their  original  weight. 
Methods  of  a  similar  kind  have  been  and  are  practiced  in  Europe  and 
America,  and  while  these  differ  considerably,  one  of  the  main  objects 
to  be  attained  always  remains  the  same,  namely,  the  inhibiting  of  the 
growth  of  germs. 

As  has  been  pointed  out  previously,  decay  is  mainly  caused  by  bac- 
teria, which  can  only  grow  w^here  moisture  and  warmth  exist,  so  that,  if 
moisture  be  removed,  gi-owth  is  inhibited,  and  the  keeping  qualities  of 
the  potato  are  prolonged  indefinitely. 

COMPOSITION  OF  DEHYDRATED  PRODUCT.—  The  composition  of  pota- 
toes which  have  undergone  one  of  these  processes  is  here  given,  together 
with  the  composition  of  raw  and  cooked  potatoes,  for  purposes  of 
comparison : 

COMPOSITION  AND  FUEL  VALUE  OF  THE  POTATO  UNDER 
VARIOUS  METHODS  OF  PREPARATION 


Sugar, 

Fuel 

Kind  of  Food 

Refuse 

Water 

Pro- 
tein 

Fat 

starch, 
etc. 

Crude 
fiber 

Ash 

value 

per 

pound 

Per  cent 

Per  cent 

Per  cent 

Per  cent 

Percent 

Percent 

Percent 

Calories 

Potato    as     pur- 

chased  

20.0 

62.6 

1.8 

.1 

13.8 

.9 

.8 

310 

Potato,  edible  por- 

tion   

78.3 
75.5 

2.2 
2.5 

.1 
.1 

18.0 
20.3 

.4 
.6 

1.0 
1.0 

375 

Potato,  boiled .  . . 

440 

Potato,  mashed 

and  seasoned .  . 

75.1 

2.6 

3.0 

17.5 

1.5 

505 

Potatoes,  fried  in 

fat,   "potato 

chips" 

2.2 

6.8 

29.8 

46.7 

4.5 

2,675 

Potato,  evap- 

orated   

7.1 

8.5 

A 

80.9 

3.1 

1,680 

White  bread 

35.3 

9.2 

1.3 

52.6 

.5 

1.1 

1,215 

Naturally,  if  extreme  heat  is  used  in  the  process,  some  of  the  starch 
content  may  be  changed  into  dextrin  and  other  minor  changes  in  the 
chemical  composition  may  take  place.     However,  there  is  no  reason  to 


APPLICATION    OF    DEHYDRATION    TO    FOODS         35 

suppose  that  the  nutritive  value  of  the  potato  is  decreased  by  these  changes. 

Langworthy,  in  the  bulletin  referred  to  above,  states  that  various 
kinds  of  desiccated  potatoes  have  been  studied  at  the  California  Agri- 
cultural Experiment  Station.  Their  water  content  ranged  from  4.8  to 
7.9  per  cent  and  their  total  carbohydrates  from  77.9  to  80.6  per  cent. 
Their  general  composition  somewhat  resembled  that  of  good  white  flour. 
They  contained  slightly  less  water,  slightly  more  carbohydrates  and 
noticeably  more  mineral  matters.  Dehydrated  potatoes  should  be  soaked 
in  water  before  use,  in  the  same  way  as  other  dehydrated  vegetables.  By 
this  means  they  will  regain  some  or  most  of  their  original  properties. 

POTATO  FLOUR.— With  regard  to  the  value  of  potato  flour,  which,  as 
just  pointed  out,  resembles  good  white  flour:  it  has  been  frequently  em- 
ployed in  the  manufacture  of  what  have  been  termed  "economy  breads." 
The  potato  is  very  largely  grown  in  Germany,  and  in  that  country  the 
value  of  the  addition  of  potato  meal  to  wheat  flour  for  the  purpose  of 
making  bread  of  a  cheaper  sort  was  recognized  in  1914  as  an  economical 
war  measure.  In  Germany  and  Austria  the  bakers  were  compelled  by 
law  to  use  at  least  30  per  cent  potato  meal  in  making  their  bread. 
It  has  been  found,  as  the  result  of  experiments  made  by  the  Bureau  of 
Chemistry  of  the  U.  S.  Department  of  Agriculture,  that  the  most  satis- 
factory loaves,  combining  economy  and  appearance,  were  those  made 
with  30  per  cent  potato  meal,  or  even  less.  The  bread  has  a  rather  coarse 
texture  and  dark  appearance,  but  is  said  to  possess  a  distinctive  and 
pleasant  flavor.  It  should  be  said  that  the  Bureau  of  Chemistry  em- 
ployed the  imported  "potato  flake"  in  some  of  its  experiments  and  in 
others  meal  made  by  slicing,  milling  and  drying  potatoes  on  a  small 
scale  in  its  laboratories. 

Sweet  Potato — The  sweet  potato,  from  a  nutritive  point  of  view,  that 
is,  from  an  analysis  of  its  component  parts,  is  similar  to  the  ordinary 
kind.  It  contains  rather  less  water  and  rather  more  carbohydrates,  and 
supplies  somewhat  more  tissue-building  material,  pound  for  pound.  The 
carbohydrates  found  in  sweet  potatoes  contain  more  sugar  than  in  the 
white  varieties,  but  the  proportion  of  sugar  and  starch  varies  with  the 
climate.  In  hot  countries  there  is  more  and  in  temperate  climates  less 
sugar. 

Dried  sweet  potatoes  were  at  one  time  a  home  product.  In  days  long 
passed,  strings  of  them  might  be  seen  han^ng  from  the  kitchen  rafters 
in  the  company  of  apples  and  other  dried  fruits  and  vegetables.  Modern 
drying  methods  and  storage  warehouses  have  almost  sounded  the  death- 
knell   of  this  custom.      When   sweet   potatoes   are   flrst   gathered,    they 


36      PRESERVATION    OF    FOODS    BY    DEHYDRATION 

are  allowed  to  "sweat"  for  some  time  before  they  are  stored.  "When 
grown  on  a  large  scale  thej  are  sometimes  ''kiln-dried,"  that  is,  sub- 
jected to  a  temperature  of  90°  E.  or  thereabouts  for  a  week  or  so.  They 
are  then  dried  more  slowly  and  at  a  lower  temperature  in  the  usual  way. 
Special  devices  for  dehydrating  sweet  potatoes,  in  the.  same  way  as  white 
potatoes  and  other  vegetables,  are  now  largely  used.  While  the  greater 
part  of  the  sweet  potato  crop  is  used  for  human  food,  stock  are  fed  with 
some  of  the  coarser  kinds;  some  also  are  used  for  the  preparation  of 
sweet  potato  flour. 

Starch-yielding  Tubers. — The  tubers  are  sliced,  dried  and  ground. 
They  are  also  used  for  the  manufacture  of  starch.  There  are  several 
tropical  starch-bearing  roots,  as  the  cassava,  yam,  yautia  and  taro.  The 
cassava  is  very  nutritious,  and  its  meal  makes  an  excellent  bread  which 
is  palatable  and  wholesome.  Analysis  of  this  vegetable  shows  water 
content  10.5  per  cent,  protein  9.1,  fat  0.3  per  cent,  total  carbohydrates 
T9,  and  a  fuel  value  of  1,650  calories  per  pound.  Yams,  often  con- 
founded with  sweet  potatoes,  belong  to  a  group  of  climbing  plants.  The 
flours  and  starches  prepared  from  these  differ  from  wheat  flour  in  that 
they  contain  no  true  gluten. 

Beets.^ — Of  the  succulent  roots,  tubers  and  bulbs,  beets  are,  on  the 
whole,  the  most  important.  These  possess  considerable  value  as  food; 
directly  they  are  used  as  vegetable  food,  also  as  the  source  of  the  sugar 
supply;  indirectly  they  contribute  on  a  very  wide  scale  to  the  food  of 
the  inhabitants  of  all  the  world  by  furnishing  provender  for  farm  animals. 

BEET-SUGAR  INDUSTRY.— No  industry  in  America  is  more  likely  to 
be  revolutionized  by  the  improvements  effected  in  the  methods  of  dehy- 
dration than  the  beet-sugar  industry.  In  1916  the  area  used  for  beet 
cultivation  amounted  to  680,000  acres,  the  beets  totalled  6,671,000  short 
tons,  and  the  production  of  sugar  was  in  the  neighborhood  of  900,000 
tons.  In  this  country  undoubtedly  suflicient  beets  can  be  grown,  and 
consequently  enough  sugar  can  be  produced  therefrom  to  make  us  inde- 
pendent of  outside  supplies.  Many  difficulties  arising  in  the  manufacture 
of  beet  sugar  may  be  wholly  or  partially  solved  by  dehydration.  "Where 
sugar  beets  are  not  grown  near  a  factory,  the  transportation  is,  generally 
speaking,  too  costly  to  render  their  cultivation  profitable.  In  the  next 
place,  the  time  for  harvesting  is  short,  and  in  order  to  preserve  the 
surplus  supply,  that  is,  the  stock  which  the  sugar  factory  temporarily 
cannot  deal  with,  it  is  frequently  deposited  in  silos.  An  inevitable  loss 
occurs,  owing  to  fermentation  or  even  to  decay  of  the  beets.  Also,  under 
existing  circumstances,  a  beet-sugar  factory  is  compelled  to  remain  idle 


APPLICATION    OF    DEHYDRATION    TO    FOODS         37 

during  some  nine  months  of  the  year,  simply  because  beets  can  be  sup- 
plied to  it  only  for  a  hundred  days  or  so  yearly. 

ADVANTAGES  OF  DEHYDRATION  OF  BEETS.— The  economic  gain  due 
to  methods  of  dehydration  would  be  very  great,  and  the  cost  of  sugar 
reduced  a  great  deal,  if  these  factories  could  work  from  the  beginning 
to  the  end  of  the  year.  The  advocates  of  dehydration  claim  that  the 
adoption  of  this  process  in  the  case  of  sugar  beets  would  bring  about  an 
ideal  state  of  affairs.  Certainly  it  would  be  possible  to  convey  the  beets 
long  distances  at  a  little  cost  on  account  of  their  small  bulk,  and  it 
would  also  be  possible  to  keep  them  without  risk  of  deterioration  until 
sUch  time  as  it  was  most  convenient  to  use  them.  The  new  scheme  pro- 
vides for  the  establishment  of  dehydrating  plants  at  points  near  refineries, 
anywhere  near  railroads  in  a  zone  of  four  hundred  miles  therefrom. 

Tlio  beets  received  from  the  farmers  of  the  neighborhood  at  the 
dehydrating  plants  could  be  cut  into  small  slices,  cossettes,  and  at  once 
dehydrated  in  this  form,  which  is  suitable  for  refining  later.  One  short 
ton  of  beets  is  reduced  in  weight  to  500  pounds  by  the  process.  Accord- 
ing to  R.  G.  Skerrett,  referred  to  previously,  the  percentage  loss  of 
cossettes,  measured  by  dry  substance  polarization,  was  only  1.66  after 
Y30  days,  and  curiously  enough  there  was  a  decrease  of  nearly  50  per 
cent  of  the  original  moisture.  Furthermore,  on  account  of  the  relatively 
low  temperature  employed,  enzymic  action  was  not  impeded  by  dehydra- 
tion, and  sugar  production  continued  for  a  time.  Hence,  dehydration 
of  the  cossettes  by  the  most  recent  process  actually  promotes  this  con- 
version of  normal  sugar  of  the  beets  and  reduces  the  cost  of  running  the 
refinery  and  of  transportation.  If  this  novel  process  of  dehydration 
exercises  such  an  effect  upon  beets,  there  is  no  need  to  expatiate  on  its 
self-evident  value. 

Carrots,  Parsnips,  Salsify,  Turnips. — Of  the  other  so-called  succulent 
root  crops  used  as  food,  carrots,  parsnips,  salsify,  turnips  and  onions 
are  the  most  common.  Carrots  are  dehydrated  on  a  large  scale  and 
resemble  fresh  carrots  in  composition. 

Dehydrated  Foods  Used  in  the  Army — In  feeding  the  soldiers  of  the 
Allied  Forces  it  was  naturally  a  stupendous  task  to  keep  them  supplied 
with  wholesome  and  nourishing  food.  Well-balanced  rations  are  essen- 
tial to  the  maintenance  of  good  health,  and  especially  to  men  engaged 
in  the  arduous  and  devitalizing  duties  of  trench  warfare.  In  order  to 
have  a  well-balanced  diet  a  sufficient  quantity  of  vegetables  is  needed; 
but  in  view  of  the  difficulties  of  transportation  across  the  Atlantic,  the 
tonnage  of  this  enormous  amount  of  vegetable  foodstuff  had  to  be  kept 


38     preservatio:n^  of  poods  by  dehydration 


Fig.  1. — The  Vegetables  at  the  Right,  When  Dried,  Will  Have  Only  the  Bulk  of 
THE  Small  Pile  at  the  Left.     (Courtesy  of  the  Scientific  American.) 


Fig.  2. — ^The  Bucket  and  Milk  Bottles  Contain  the  Water  Extracted  from  Tiiia 
Box  of  Vegetables.     (Courtesy  of  the  Scientific  American.) 


ArrLlCATlO.X    OF    iJEUYDllATlON    TO    FOODS 


39 


as  low  as  possible,  while  at  the  same  time  furnishing  the  field  kitchens 
with  adequate  stores.  It  was  entirely  beyond  the  scope  of  human  en- 
deavor, in  fact,  for  the  warring  governments  to  ship  whole  cargoes  of 
fresh  vegetables  in  cold  storage  and  later  to  transfer  and  convey  them 
many  hundreds  of  miles  to  the  firing  lines.  For  a  long  time  canned 
vegetables  were  in  great   demand,   indeed  vegetable  food   was  shipped 


Fig.  3. — ^Tiiis  Barrel  of  Dehydrated  Vegetables  Represents  Thirty  Barrels  of 
Green  Vegetables.  It  is  sufficient  to  make  soup  for  6,000  men.  (Courtesy  of  the 
Scientific  American.) 


mainly  in  this  form.  The  French  were  the  first  to  recognize  the  possi- 
bilities of  dehydrated  vegetables  as  an  economical  measure,  and  from 
this  country  and  Canada  have  imported  tremendous  quantities  of  vege- 
tables treated  by  this  process.  Celery,  cabbage  and  carrots  are  largely 
grown  in  Monroe  and  Wayne  counties,  'New  York,  where  there  are  a 
large  number  of  evaporators.  Accordingly  this  part  of  New  York  State 
was  drawn  upon  for  supplies  of  these  dehydrated  vegetables.     At  the 


40       PKESERVATIOX    OF    FOODS   BY    DEHYDRATION" 

time  of  writing  the  French  Government  contracts  with  a  produce  com- 
pany of  Belleville,  Ontario,  to  furnish  its  War  Department  with  all  the 
dehydrated  vegetables  it  can  supply.  The  vegetables  desired  are  celery, 
cabbage,  carrots,  onions,  potatoes  and  turnips.  These  crops  when  dehy- 
drated are  mixed  after  a  certain  formula  and  placed  in  fifteen-pound 
cans,  which  are  sealed  and  shipped  to  the  French  Army,  where  they  are 
used  for  making  stews  for  the  soldiers. 

Celery. — Celery  for  dehydrating  purposes  may  be  in  almost  any  con- 
dition, as  long  as  it  is  free  from  disease.  Any  variety  may  be  used,  but 
the  unblanched  green  winter  kind  is  preferred,  as  it  retains  its  flavor 
and  color  best.  The  celery  is  packed  in  the  rough  or  is  conveyed  loose 
to  the  evaporator,  where  it  is  weighed  and  stacked  ready  for  further 
preparation  and  treatment.  After  the  roots  and  dead  leaves  have  been 
removed,  the  celery  is  placed  in  the  washing  vat,  thoroughly  cleansed, 
and  is  then  carried  to  the  cutting  machine,  whence  the  shredded  celery 
drops  into  a  box  through  which  runs  a  continuous  belt  elevator.  In  th;s 
manner  the  shredded  material  is  taken  to  the  second  floor,  where  it  is 
caught  in  large  baskets  and  conveyed  to  the  drying  bins. 

METHOD  OF  DEHYDRATION.— The  kiln  method  is  employed  here 
which  is  fully  described  in  Farmers'  Bulletin  No.  291.  Before  placing 
the  shredded  celery  in  the  drying  bin,  the  kilns  are  heated  to  a  tempera- 
ture of  160°  to  180°  F.  After  the  process  has  been  completed  the  celery 
is  shoveled  from  the  bin  and  placed  in  bags  for  shipment. 

Cabbage,  Onions,  etc — The  processes  involved  in  the  dehydration  of 
cabbage  are  similar  to  those  used  for  celery,  except  that  the  cabbage  is 
not  cleaned  before  shredding.  The  method  used  in  drying  onions  is 
very  like  the  method  just  described.  The  preparation  of  the  product 
before  shredding,  however,  is  different.  The  tops  and  remains  of  roots 
are  removed  by  hand  and  the  onion  is  peeled  by  machinery.  It  is 
shredded  before  being  elevated  to  the  drying  bins.  The  relative  weights 
of  green  vegetables  and  those  which  have  undergone  the. kiln  evaporator 
process  are  as  follows : 

1  ton  of  green  celery  ....  150  pounds  when  dried 

1  ton  of  gTcen  cabbage  ..  .  150  to  175  pounds  when  dried 

1  ton  of  green  carrots  ....  200  pounds  when  dried 

1  bushel  of  onions 5  pounds  when  dried 

Under  the  contract  with  the  French  Government  the  finished  product 
is  allowed  to  contain,  at  the  maximum,  15  per  cent  of  moisture.  This 
requires  a  drying  period  of  from  twelve  to  fourteen  hours,  according  to 


APPLICATION    OF    BEHYDEATION    TO    FOODS         41 

the  degree  of  heat  produced  by  the  kihis.     The  cost  of  treating  the  vege- 
tables by  the  above  process  is  as  follows: 

Green  celery .  $10  per  ton 

Cabbage $8  per  ton 

Carrots $10  per  ton 

Onions 10  cents  per  bushel 

ADVANTAGES  OF  THE  KILN  METHOD  FOR  THESE  VEGETABLES.— 
The  kiln  process  has  been  in  vogue  the  longest  and  is  at  the  present  time 
most  used  in  this  country.  The  use  of  circulating  heated  air  at  a  com- 
paratively low  temperature  for  dehydrating  vegetables  is  theoretically 
scientific  and  practically  is  superior  to  methods  which  rely  upon  heat 
alone,  or  mainly,  as  a  means  of  dehydration.  Turnips,  parsnips  and  all 
other  vegetables  can  be  dehydrated,  and  the  description  of  the  procedure 
followed  in  one  case  will  apply  to  all.  Fresh  carrots  contain :  refuse,  20.0 
per  cent;  water,  88.2  per  cent;  protein,  1.1  per  cent;  fat,  A  per  cent; 
sugar,  starch,  etc.,  8.2  per  cent;  crude  fiber,  1.1  per  cent  and  ash,  1.0  per 
cent.  The  fuel  value  per  pound  is  210  calories.  Carrots  dried  by  the 
kiln  process  contain:  water,  3.5  per  cent;  protein,  7.7  per  cent;  fat,  .6  per 
cent;  sugar,  starch,  etc.,  crude  fiber,  83.3  per  cent;  and  ash,  4.9  per  cent. 
Fuel  value  per  pound,  1,790  calories. 

Beans — It  is  often  said,  and  indeed  the  view  is  widely  circulated, 
that  dried  legumes  are  the  rational  and  the  best  substitutes  for  meat. 
This  is  true  to  a  large  extent,  as  the  dried  legume  is  very  rich  in  protein 
and  in  energy-giving  constituents.  However,  drawbacks  exist  in  certain 
legumes,  principally  in  beans,  which  somewhat  detract  from  their  food 
value.  In  the  first  place,  in  preparing  beans  for  the  table  by  the  usual 
methods,  they  become  less  concentrated,  whereas  the  cooking  of  meat 
renders  it  more  concentrated.  In  the  one  case  water  has  been  added; 
in  the  other  water  has  been  removed  by  the  roasting  or  broiling.  Dried 
beans  are  also  liable  to  cause  flatulence,  due  to  the  slow  rate  at  which 
they  are  digested  and,  perhaps,  to  their  sulphur  content.  Still,  it  can- 
not be  denied  that  dried  beans  and  lentils  are  wholesome,  valuable  and 
nutritious  foods  which  may  be  prepared  in  many  ways  as  the  staple  diet, 
and  which  are,  all  in  all,  the  most  satisfactory  substitutes  for  meat. 

COMPOSITION  OF  FRESH  AND  DRIED  BEANS.— The  following  •  table, 
taken  from  Farmers^  Bulletin  121 — 315  of  the  U.  S.  Department  of 
Agriculture,  shows  the  composition  of  fresh  and  dried  legumes,  compared 
with  that  of  some  other  foods: 


42     presekvatio:n^  of  foods  by  dehydration 

COMPOSITION  AND  FUEL  VALUE  OF  FRESH  AND  DRIED 

LEGUMES 


Material 


Water 


Protein 


Fat 


Carbo- 
hydrate 


Ash 


Fuel 

value 

per 

pound 


Fresh  legumes: 
String  beans 

"      peas 

Shelled  kidney  beans .  .  . . 

"       lima  beans 

**       peas 

"       cowpeas 

Canned  string  beans 

"       Uma  beans 

"       kidney  beans. . .  . 

"       peas 

Dried  legumes : 

Lima  beans 

Navy  beans 

Lentils 

Peas 

Cowpeas 

Soy  beans 

Cluck  peas 


Per  cent 

89.2 
81.8 
58.9 
68.5 
74.6 
65.9 
93.7 
79.5 
72.7 
85.3 

10.4 
12.6 
8.4 
9.5 
13.0 
10.8 
14.8 


Per  cent 

2.3 
3.4 
9.4 
7.1 
7.0 
9.4 
1.1 
4.0 
7.0 
3.6 

18.1 
22.5 
25.7 
24.6 
21.4 
34.0 
12.4 


Per  cent 

.3 
.4 
.6 
.7 
.5 
.6 
.1 
.3 
.2 
.2 

1.5 

1.8 
1.0 
1.0 
1.4 
16.8 
6.7 


Per  cent 

7.4 
13.7 
29.1 
22.0 
16.9 
22.7 

3.8 
14.6 
18.5 

9.8 

65.9 
59.6 
59.2 
62.0 
60.8 
33.7 
63.3 


Per  cent 


.7 
2.0 
1.7 
1.0 
1.4 
1.3 
1.6 
1.6 
1.1 

4.1 
3.5 
5.7 

2.9 
3.4 

4.7 
2.8 


Calories 

195 
335 
740 
570 
465 
620 
95 
360 
480 
255 

1,625 
1,605 
1,620 
1,655 
1,590 
1,970 
1,690 


As  the  great  majority  of  these  legumes  are  lacking  in  fat,  it  is  a 
rational  and  natural  proceeding  to  add  salt  pork  to  the  baked  beans  and 
bacon  to  cowpeas. 

It  may  be  estimated  that  a  pint  of  these  dried  legumes  and  a  half 
pound  of  pork  have  a  protein  content  exceeding  a  pound  and  a  half  of 
uncooked  meat  of  average  composition.  ^loreover,  since  this  combina- 
tion is  rich  in  starch  as  well  as  in  fat  and  protein,  it  may  serve  as  a 
substitute  for  potato  and  meat. 

LIMA  BEANS.— Lima  beans  possess  great  fuel  value.  They  are,  how- 
ever, not  sufficiently  appreciated  as  a  table  food  because  it  is  not  generally 
known  that  they  can  be  used  in  a  dried  state  in  practically  the  same 
manner  as  are  the  common  beans.  In  reality  they  are  richer  and  more 
delicate  in  flavor  than  the  common  beans. 

SOY  BEAN.— In  far  Eastern  countries,  where  the  supply  of  animals 
suitable  for  food  is  small  and  where  a  large  proportion  of  the  inhabitants 
are  interdicted  by  religion  and  caste  from  killing  or  eating  animals, 
recourse  has  been  had  to  the  vegetable  kingdom  to  make  up  this  lack  of 
animal  food.    Legumes  are  the  vegetables  used,  the  soy  bean  in  particu- 


APPLICATION    OF    DEIIYDKATIOX    TO    FOODS         43 

lar.  Although  somewhat  of  a  digression,  it  will  not  be  out  of  place  to 
state  in  this  connection  that  the  soy  bean  is  more  important  than  rice 
as  food  for  the  inhabitants  of  Asia.  The  idea  is  popular  that  the  people 
of  India  and  China  subsist  almost  wholly  upon  rice,  whereas  the  truth 
is  that,  while  enormous  quantities  of  rice  are  consumed  in  these  coun- 
tries, the  soy  bean  supplies  the  protein  element  essential  to  the  conser- 
vation of  health. 

The  soy  bean  is  employed  by  these  peoples  in  a  variety  of  ways. 
The  nitrogenous  material  and  a  considerable  amount  of  the  fat  of  the 
beans  are  separated  and  made  into  a  number  of  special  articles  of  diet, 
as  bean  cheese  or  bean  curd,  and  soy,  a  thick  brown  sauce  used  by  millions 
of  people  as  a  flavoring  material  and  condiment.  By  this  means  the 
necessary  nitrogenous  element  and  flavor  are  added  to  the  otherwise  taste- 
less rice,  vegetables  and  other  foods  which  form  their  diet. 

Soy  Bean  Flour. — A  soy  bean  flour  has  been  made  which  is  said  by 
Friedenwakl  and  Euhrah(12)  to  be  most  useful.  It  has  the  following 
composition : 

Constituent  Per  Cent 

Protein    44.64 

Fat    19.43 

Mineral  matter 4.20 

Moisture  5.26 

Crude  fiber 2.35 

Cane  suj^ar    9.34 

Non-nitrogenous  extract   14.78 

Stareli    none 

Reducing  sugars  none 

Polarization  normal  weight  due  to  optically  active  substance 
other  than  cane  sugar  included  in  protein  and  non- 
nitrogenous  extract   7.80 

The  percentage  of  protein  in  this  flour  is  almost  one-third  greater  than 
the  percentage  of  protein  in  the  whole  beans.  This  is  caused  by  remov- 
ing the  coarse  fibrous  hulls  which  contain  little  protein.  The  composition, 
of  this  flour  may  be  compared  with  round  of  beef,  medium,  which  con- 
tains: protein,  Ift.O  per  cent;  fat,  12.8  per  cent;  and  moisture,  60.7  per 
cent.  Each  ounce  of  this  soy  gruel  flour  yields  about  13  grams  of  pro- 
tein and  120  calories.  It  can  be  used  as  a  gruel,  in  broths  and  in 
making  biscuits. 

COOKING  OF  BEANS.— As  W.  S.  Hall (13)  has  pointed  out,  dried 
legumes  require  very  thorough  cooking,  considerably  more  than  other 
foods.     This  prolonged  cooking  is  necessary  because  the  nutrients,  en- 


44      PRESERVATION    OF    FOODS    BY    DEHYDRATION 

closed  within  the  walls  of  the  plant  cells,  are  inaccessible  to  the  digestive 
juices  until  the  cell  walls  have  been  broken  down  by  cooking  and  masti- 
cation. The  grinding  of  dried  legumes  into  meal  greatly  facilitates  the 
cooking  and  the  mastication,  and  in  consequence  the  digestibility.  Owing 
also  to  the  fact  that  dried  legumes,  such  as  navy  beans  and  dried  peas, 
are  somewhat  difficult  of  digestion,  unless  made  into  purees,  they  are  less 
well  adapted  for  general  use  in  the  dietaries  of  people  of  sedentary  occu- 
pation than  for  those  who  are  engaged  in  active  out-of-door  pursuits. 

FOOD  VALUE  OF  BEANS.— The  high  nutritive  value  of  dried  beans, 
cowpeas  and  other  legumes,  due  to  their  protein  content,  renders  this 
class  of  food  very  useful  as  meat  substitutes.  Comparing  the  nutritive 
value  of  dried  legumes  and  meat,  it  is  found  that  two-thirds  of  a  pint  of 
dried  beans,  cowpeas  or  lentils  is  equal  to  one  pound  of  heef  of  average 
composition. 

Corn — In  earlier  times  com  was  dried  or  evaporated  for  domestic 
use  by  most  housewives  in  rural  districts,  and  at  the  present  time  sweet, 
corn  in  the  milky  stage  of  its  development  is  frequently  preserved  by 
means  of  dehydration.  Sweet  corn  is  a  satisfactory  vegetable  to  dehy- 
drate.    It  retains  its  flavor  and  sugar  content  to  a  remarkable  degree. 

RELATION  OF  SPOILED  CORN  TO  PELLAGRA.— One  of  the  chief  theories 
as  to  the  causation  of  pellagra  is  that  it  is  due  to  the  eating  of  spoiled 
corn,  the  staple  diet  of  the  inhabitants  of  those  countries  or  districts  in 
which  the  disease  is  most  prevalent.  In  Italy,  this  belief,  inspired  and 
fostered  b}"^  the  views  of  Lombroso,  has  been  responsible  for  prophylactic 
measures  directed  mainly  against  the  use  of  damaged  com  as  an  article 
of  food.  Dehydrating  or  desiccating  plants  have  been  established  for 
the  artificial  drying  of  corn  there  to  prevent  waste.  These  desiccators 
are  of  two  types,  fixed  and  portable.  At  present  there  are  a  large  num- 
ber of  public  plants  for  dehydrating  corn  throughout  Italy. 

Use  of  Vegetable  Flours. — In  a  previous  part  of  this  chapter  reference 
has  been  made  to  "economy  loaves."  These  are  made  partially  or  wholly 
from  a  flour  less  expensive  in  these  days  and  more  easily  obtainable 
than  wheat  flour.  The  advantages  of  dried  bananas  among  the  fruit 
products  and  dehydrated  potatoes  among  the  vegetable  products  were 
discussed.  Other  flours  made  from  fruits  and  vegetables — from  dried 
chestnuts,  the  soy  bean,  the  white  bean  and  several  other  varieties  of 
bean,  cottonseed,  cassava  and  peas — offer  promise  of  furnishing  the 
public  with  a  cheap  and  nutritious  bread.  The  soy  bean  and  cottonseed 
flours  when  mixed  with  wheat  flours  in  proper  proportions,  about  25  per 
cent,  furnish  a  bread  with  about  twice  the  amount  of  protein  that  ordinary 


SUMMARY  45 

wheat  bread  contains.  Stress  should  be  laid  upon  the  fact  that  wheat 
flour  is  not  essential  for  the  production  of  a  good,  nutritious  and  whole- 
some bread.  A  bread  made  of  some  other  cereal,  of  corn,  for  example,  will 
in  almost  all  respects  equal  bread  made  from  wheat  flour.  The  addition 
of  a  vegetable  or  fruit  to  wheat  flour,  as  the  dried  potato,  bean,  banana 
or  chestnut,  will  not  detract  from  the  food  value  and  will  be  more  eco- 
nomical and  quite  as  satisfactory  as  a  bread  made  from  wheat  flour, 
cornmeal  or  rye  flour  alone. 

Yeast. — A  food  material  which  comes  under  the  head  of  vegetable 
products  and  which  when  dehydrated  is  now  somewhat  largely  used  as 
food  for  man  and  beast,  is  yeast.  The  main  object  in  drying  yeast  is 
to  utilize  to  the  fullest  extent  its  excellent  food  properties  and  to  make 
it  available  for  transportation  over  long  distances.  Up  to  the  present 
time  the  constructors  of  yeast  dehydrators  have  relied  chiefly  upon  the 
experience  gained  in  the  construction  of  potato  driers.  The  working 
principle  of  all  the  yeast  driers  on  the  market  is  practically  the  same. 
The  moist  yeast  passes  over  steam-heated  cylinders,  where  it  is  freed 
from  most  of  its  water  in  the  fraction  of  a  minute.  Scientific  researches 
have  shown  that  dehydrated  yeast  is  one  of  the  richest  of  concentrated 
foods,  and  attention  may  be  called  to  the  fact  that  the  food  value  of  such 
yeast  cannot  be  estimated  in  the  same  way  as  the  food  value  of  other 
foods,  such  as  potatoes,  wheat  or  corn.  It  is  considerably  higher  on  account 
of  special  dietetic  properties.     Yeast  has  a  very  high  vitamine  content. 

Dry  yeast  has  given  good  results  when  fed  to  domestic  animals.  It  is 
stated  that  when  milch  cows  are  fed  upon  it  the  yield  of  butter  is  increased. 

According  to  J.  C.  Smith  (14),  it  has  been  demonstrated  that  a 
great  many  inexpensive  and  nutritive  dishes  can  be  prepared  from  de- 
bittered,  dried  yeast,  and  physiological  experiments  have  shown  that  this 
food  yeast  is  wholesome  and  very  easily  digested.  Experiments  have 
shown  that  one  pound  of  dried  yeast  is  equal  in  food  value  to  3.3  pounds 
of  average  fat  beef,  and  furthermore  its  advocates  state  that  it  is  not 
only  valuable  as  an  article  of  food,  but  is  indicated  as  a  means  of  invig- 
orating devitalized  individuals. 

SUMMARY 

The  domestic  dehydration  of  vegetables  and  fruits  is  becoming  a 
quite  common  practice.  The  best  and  most  efficient  form  of  a  home 
dehydrator  is  that  which  withdraws  the  water  by  the  agency  of  dry 
steam,  and  not  by  hot  air. 


46       PRESEKVATION    OF    FOODS    BY   DEHYDRATIOK 

Success  of  Dehydration. — Practically  all  vegetables  and  fruits  can  be 
successfully  dehydrated  commercially  by  employing  heated  air  at  a  com- 
paratively low  temperature  for  a  rather  short  period  of  time.  In  this 
process  the  air  currents  should  thoroughly  penetrate  the  vegetables  and 
fruits  subjected  to  the  treatment.  To  a  lesser  extent  the  above  remarks 
apply  to  the  dehydration  of  animal  foods.  Meat  does  not  lend  itself 
particularly  well  to  this  mode  of  preservation,  but  the  desiccation  of 
milk  with  retention  of  its  solubility,  nutritive  properties  and  vitamine 
elements  intact,  if  not  an  accomplished  fact,  is  in  a  fair  way  of  becoming 
so  ere  long.  As  Mendel  has  said,  "If  the  best  dried  milk  of  the  future 
shall  be  shown  to  retain  even  the  more  subtle  physiological  properties, 
such  as  its  antiscorbutic  potency,  it  will  represent  good  achievement." 
A  dried  milk  does  not  deteriorate  and  is  sterile,  most  important  factors 
in  the  conservation  of  the  public  health. 

"With  the  possible  exception  of  milk,  the  dehydration  of  animal  foods 
has  not  been  as  successful  as  in  the  case  of  vegetables  and  fruits.  The 
dehydration  of  fruit  is  quite  satisfactory,  so  also  is  the  dehydration  of 
vegetables.  The  flavor  and  taste  of  certain  fruits  are  more  apt  to  be 
altered  or  attenuated  than  that  of  vegetables. 

Economic  Advantages — From  the  economic  aspect,  dehydration  of  food- 
stuffs seems  destined  to  revolutionize  the  entire  food  situation.  The 
immense  waste  of  vegetables  and  fruits  which  is  now  universal  should  be 
prevented  in  the  future.  The  farmer  or  producer  of  food  products  will 
be  independent  of  the  local  markets.  His  produce  will  be  dehydrated 
on  the  most  approved  system  at  a  nearby  plant.  Such  produce,  on 
account  of  its  keeping  properties,  comparative  lightness  and  small  bulk, 
can  be  delivered  at  a  low  cost  in  this  country  or  abroad.  Vegetables 
weighing  a  pound  can  be  transported  thousands  of  miles  and  made  into 
soup  or  stew  sufficient  for  fifty  or  sixty  hearty  adults. 

The  value  of  dehydration  methods  of  preserving  food  to  exploring 
parties,  to  workmen  engaged  in  operations  in  out-of-the-way  parts  of  the 
world  and  so  on,  is  so  patent  as  to  require  neither  emphasis  nor  elabo- 
ration. Enough  has  been  said  on  the  subject  of  dehydration  to  show  that 
when  carried  out  in  a  strictly  scientific  manner,  it  is  a  long  step  in  the 
direction  of  the  ideal  system  of  economizing  the  food  supply  of  a  nation. 

In  this  chapter  a  certain  amount  of  repetition  may  be  obsen-ed. 
This  has  been  done  intentionally  in  order  to  emphasize  the  need  for 
economy  of  food  products  and  to  draw  attention  to  dehydration  as  an 
important  factor  in  the  achievement  of  this  object. 

The   war   has   had   some   redeeming   features,    some    advantages    to 


SUMMARY  47 

counterbalance,  in  a  slight  degree,  the  dreadful  loss  of  human  life  and 
the  reversion  to  barbarism  which  have  blackened  its  course.  It  has 
aroused  the  race  from  the  slough  of  self-indulgence  and  apathj  with 
which  many  years  of  peace  and  prosperity  had  imbued  its  members, 
and  has  taught  them  with  the  whip  of  adversity  that  self-restraint  and 
endurance  were  still  to  be  regarded  as  ]iigh  among  the  cardinal  virtues. 
Perhaps  no  calamity  brought  about  by  the  war  has  served  better  to  teach 
this  lesson  than  the  lack  of  food.  Shortage  of  the  food  supply  quickly 
brings  home  to  all  sorts  and  conditions  of  men  and  women  the  truth 
that  food  is  after  all  one  of  the  essentials  of  life  and  that  without  a  suffi- 
cient provision  of  food,  life  is  hardly  worth  living.  Consequently,  one 
of  the  eifects  of  the  war  has  been  to  quicken  man's  brain  to  devise  means 
for  producing  more  food,  to  economize  that  which  has  been  produced, 
to  search  out  and  cultivate  foods  which  can  be  more  easily  and  cheaply 
produced,  and  to  be  satisfied  with  simpler  and  more  wholesome  food 
products.  The  fear  of  famine  has  spurred  him  on  in  this  endeavor. 
Therefore  it  may  be  said  with  truth  that  the  war  will  be  responsible  for 
at  least  a  partial,  if  not  the  complete,  solution  of  the  food  problem,  and 
that  the  development  of  such  measures  as  dehydration  of  foodstuffs  is 
an  indirect  consequence  of  the  war. 

REFERENCES 

1.  Skerrett,  R.  G.     Scient.  Am.,  March  10,  1917. 

2.  Burgess,  H.  J.     Pure  Products,  Aug.,  1914. 

3.  Wells,  Levi.     Yearbook  of  the  Dept.  of  Agric,  1912. 

4.  Pritchard,  Eric.     The  Infant,  Nutrition  and  Management. 

5.  Cautley.    Sutherland's  System  of  Diet  and  Dietetics. 

6.  Pennington.     U.  S.  Dept.  of  Agric,  Bur.  of  Chem.,  Circular  98. 

7.  Stiles  and  Bates.     U.  S.  Dept.  of  Agric,  Bur.  of  Chem.,  Circu- 

lar 104. 

8.  Burger,  A.  F.    Pine  Products,  Oct.,  1913. 

9.  Lang  WORTHY,  C.  F.     Yearbook  of  the  Dept.  of  Agric,  1912. 

10.  Gould,  H.  P.    U.  S.  Dept.  of  Agriculture,  Farmers'  Bull.  293. 

11.  Langworthy,  C.  F.     U.  S.  Dept.  of  Agriculture,  Farmers'  Bull. 

295. 

12.  Friedenwald  and  Ruhrah.    Diet  in  Health  and  Disease. 

13.  Hall,  W.  S.     Nutrition  and  Dietetics. 

14.  Smith,  J.  C.     Pure  Products,  Aug.,  1913. 


CHAPTER   III 

SCIENTIFIC    COOKERY 
H.  S.  Grindley,  B.S.,  Sc.D. 

We  may  live  without  poetry,  music  and  books,  but  civilized  man  cannot  live 
without  cooks.     (Owen  Meredith.) 

History  of  Cooking. 

Principles  of  Scientific  Cooking:  Changes  Produced  by  Cooking;  Evil 
Effects  of  Poor  Cookery. 

Varieties  of  Cookery:  Meat — Boiling,  Stewing,  Frying,  Baking,  Roasting, 
Broiling,  Braising,  Steaming;  Losses  in  Cooking  Meat;  Cooking  of 
Fish;   Cooking  of  Vegetable  Foods. 

Food  Concentration:  Desiccation;  Concentrated  Proteins;  Dried  Vegeta- 
bles;   Desiccated   Milk;    Desiccated  Eggs;    Meat. 

HISTORY    OF    COOKING 

Cooking  as  an  art  has  been  developed  from  the  crude  methods  used  by 
primitive  peoples  from  almost  the  beginning  of  time.  The  early  Egyp- 
tians, it  is  said,  had  professional  bakers.  We  read  of  their  roasting  and 
boiling. the  flesh  of  oxen.  The  Greeks  attributed  the  discovery  of  bread- 
making  to  the  god  Pan,  but  bread  was  in  use  among  the  Chaldeans  and 
Egyptians  before  the  Greek  gods  had  their  inception.  Ching-Nong,  1998 
B.C.,  is  reputed  to  have  been  the  first  who  taught  men  the  science  of  mak- 
ing bread  from  wheat.  So  we  see  that  bread  is  a  very  ancient  food,  its 
origin  being  lost  in  the  mists  of  antiquity.  In  the  days  of  the  patriarch 
Abraham,  his  wnfe,  Sarah,  made  cakes  which  were  thought  to  be  a  fit  offer- 
ing for  angels.  Prior  to  the  bondage  of  the  Israelites  in  Eg;\'pt,  baking 
had  become  a  highly  perfected  art.  The  Egyptians  used  many  varieties 
of  flour  and  made  cAkes  of  various  kinds  and  shapes.  According  to  sacred 
history,  one  of  the  most  important  servants  in  the  service  of  Pharaoh,  dur- 
ing Joseph's  regime,  was  a  professional  baker. 

49 


50  SCIENTIFIC    COOKERY 

There  appears  to  have  been  cousiderable  difference  as  to  the  manner 
in  which  good  eating  was  appreciated  by  the  early  Greeks.  After  the 
Homeric  age  of  simplicity,  in  which  roast  and  boiled  meats  seem  to  have 
sufficed  the  kingly  table,  a  diversity  of  preparation  was  attained  in  cook- 
ing, and  a  certain  epicureanism  was  displayed  in  the  quality,  seasoning 
and  method  of  dressing  food.  The  Greeks  boiled  and  roasted  the  flesh  of 
sheep,  pigs,  lambs  and  goats.  They  cooked  poultry,  small  birds,  game  and 
sausage.  Fish  was  the  principal  article  of  food  with  all  classes  of  Greeks, 
but  with  the  wealthier  classes  much  skill  and  delicacy  were  attained  in 
the  stuffing  and  cooking  of  fish.  The  Eomans(l)  were  not  far  behind 
their  Greek  brothers  in  the  culinary  art ;  by  degrees,  however,  a  taste  for 
better  eating  crept  in ;  and  after  the  Asiatic  conquest,  luxury  in  eating 
was  introduced  by  Lucullus.  There  is  plenty  of  evidence  that  primitive 
peoples  of  all  races,  savage,  semi-savage  and  civilized,  barbecued  their 
meats  over  heaps  of  live  coals,  or  roasted  over  the  coals  pieces  of  flesh 
cut  or  torn  from  big  game.  Small  animals  w^ere  sometimes  roasted  whole 
over  the  coals  and  sometimes  they  were  incased  in  mud  and  then  baked  in 
hot  ashes. 

Prehistoric  man  may  have  lived  wholly  on  raw  food,  berries,  fruits, 
shellfish,  etc.  (see  Chapter  I,  Volume  I,  The  Evolution  of  Man's  Diet), 
but  this  diet  is  not  suited  for  most  races  of  man  today,  although  the  north- 
ern Eskimo  still  prefers  to  eat  his  meat  raw  and  frozen.  While  it  is  pos- 
sible for  man  to  live  upon  raw  food  for  a  considerable  length  of  time,  it 
is  apparently  designed  by  nature  that  a  large  portion  of  his  food  should 
be  cooked,  for  there  are  no  savage  races  who  do  not  practice  the  art  of 
cooking,  in  however  elementary  a  fashion,  and  progress  in  the  scale  of 
development  and  civilization  is  uniformly  accompanied  by  advance  in  the 
art  of  cooking. 

Of  ancient  British  cookery  very  little  is  known ;  no  doubt  it  was  crude. 
We  find  but  little  mentioned  of  the  art  of  cooking  in  the  Saxon  Chronicles. 
The  Danes  and  Germans  appear  to  have  been  great  drinkers  and  to  have 
paid  little  attention  to  the  preparation  of  foods.  The  ISTormans  were  more 
particular  in  these  matters ;  some  offices  among  them  were  held  by  right 
of  the  kitchen.  We  do  know,  however,  that  the  mortar  was  extensively 
used  by  the  Anglo-Saxons  and  that  oil  and  lard  were  used  instead  of  butter. 

The  French  were  the  first  to  introduce  art  into  the  process  of  prepar- 
ing foods,  but  it  was  not  until  the  introduction  of  Italian  taste  by  the  prin- 
cesses of  the  House  of  ^fedici  that  cooking  became  an  art.  The  ancient 
use  of  oil  was  modified  through  the  discovery  made  by  the  French  of 
dressing  meat  in  its  own  gravy^,  and  at  the  present  day  it  is  universally 


PEINCIPLES    OF    SCIEj^TIFIC    COOKING  51 

admitted  that  the  French  cook  is  a  true  gastronomic  artist,  and  it  is  for 
his  perfection  in  this  art  that  all  the  hotels  of  any  importance  in  this 
country  employ  a  Frenchman  to  fill  the  post  of  chef  de  cuisine.  The  esti- 
mation in  which  his  services  are  appreciated  may  be  understood  by  the 
large  salary  attached  to  this  office  in  fashionable  hotels  and  club  houses. 
A  visit  to  the  kitchen  of  one  of  these  establishments  shovi^s  what  a  highly 
important  post  he  fills.  Such  a  person  should  know  not  only  how  things 
are  to  be  done,  but  he  should  have  the  organizing  ability  to  arrange  and 
direct  the  work  of  the  numerous  assistants. 

During  the  past  decade  the  art  cf  cooking  as  a  branch  of  woman's  edu- 
cation has  been  given  considerable  attention  in  this  country.  Domestic 
science  classes,  in  connection  with  universities  and  other  institutions  of 
learning  for  young  women,  have  been  established  in  New  York,  Boston, 
Philadelphia  and  other  places. 

PRINCIPLES   OF   SCIENTIFIC    COOKING 

It  is  an  error  to  suppose  that  cooking  increases  the  digestibility  of  all 
food ;  this  is  not  the  case  with  animal  foods,  as  cooking  diminishes  rather 
than  increases  their  digestibility.  Proper  cooking  increases  the  digesti- 
bility of  vegetable  foods  by  breaking  down  their  cellulose  coverings, 
thereby  allowing  rupture  of  the  starch  grains,  which  aids  the  free  admix- 
ture of  the  digestive  juices  and  hastens  the  chemical  process  of  diges- 
tion (1). 

Generally  speaking,  all  foods  except  fruits  having  organized  structure 
require  cooking.  It  is  well  known  that  the  majority  of  fruits,  and  some 
vegetables,  are  eaten  raw  by  preference,  without  interfering  with  the  appe- 
tite;  but  food  from  the  animal  kingdom,  as  a  rule,  requires  thorough  cook- 
ing. Raw  animal  food  has  been  eaten  by  man,  but  it  becomes  wearisome ; 
an  exclusive  animal  diet  soon  excites  disgust.  Milk,  eggs,  oysters  and 
clams  are  an  exception. 

While  the  physician  need  not  be  a  cook,  he  should  understand  the  gen- 
eral methods  of  preparing  foods,  and  should  know  the  ingredients  of  com- 
pound dishes  just  as  thoroughly  as  he  knows  the  meaning  of  Galenical 
terms  and  the  ingi-edients  of  tinctures,  compound  powders,  pills,  etc.  If 
he  is  ignorant  of  the  composition  and  proper  preparation  of  foods,  he  can- 
not intelligently  supervise  the  diet  of  his  patients.  He  should  study 
dietetics  exactly  as  he  studies  the  pharmacopoem  or  a  work  dealing  with 
pharmacognosy  or  materia  medica,  not  that  he  need  master  the  art  either 
of  cooking  or  pharmacy,  but  that  he  may  have  an  intelligent,  general  com- 
prehension of  both  subjects. 


52  SCIENTIFIC    COOKERY 

The  essential  part  of  all  cooking  processes  is  the  scientific  application 
of  heat,  and  it  is  important  to  have  a  clear  understanding  of  the  effects 
of  heat  upon  the  various  chemical  constituents  of  food.  For  instance,  heat 
coagulates  the  protein  of  foods ;  still  it  would  be  erroneous  to  suppose  that 
a  boiling  temperature  is  necessary  to  bring  about  this  change,  since  pro- 
teins, both  animal  and  vegetable,  are  coagulated  if  their  temperature  is 
raised  to  170°  F.  Ignorance  of  this  fact  is  a  fertile  source  of  error  in 
cooking.  When  the  temperature  of  a  piece  of  meat  is  raised  much  above 
this  point,  the  protein  is  hardened  and  shrunken,  and  the  digestibility  of 
the  meat  is  proportionally  lessened. 

The  vegetable  foods  are  more  readily  affected  by  heat  than  animal 
foods,  and  of  the  carbohydrate  foods,  starch  is  most  affected.  Dry  heat 
applied  to  raw  starch  converts  a  poi'tion  of  it  into  soluble  form,  and  ulti- 
mately into  dextrin.  This  is  accomplished,  to  a  slight  extent,  in  the  outer 
crust  of  bread  and  in  the  preparation  of  toast.  Moist  heat  applied  to 
starchy  foods  causes  the  starch  molecules  to  swell,  bursting  the  cellulose 
coverings,  when  the  foods  are  said  to  be  gelatinized.  This  occurs  below 
the  boiling  point  of  water,  as  shov/n  by  the  following  table  giving  the 
gelatinization  points  of  different  kinds  of  starch : 

GELATINIZATION   POINTS    OF   VARIOUS    STARCHES 

Oats    185°  F. 

Barley    176°  F. 

Rye  176°  F. 

Wheat    176°  F. 

Rice    176°  F. 

Maize 167°  F. 

Potato    149°  F. 

From  the  above  table  it  is  observed  that  the  gelatinization  of  starches 
can  be  effected  at  comparatively  low  temperatures.  In  the  chapter  on 
Sugars,  Spices  and  Condiments  (Volume  I,  Chapter  XVII),  the  effect  of 
heat  on  sugar  has  been  described,  and  therefore  it  need  only  be  mentioned 
here  that  the  partial  conversion  of  sugar  into  caramel  is  one  of  the  means 
by  which  flavor  is  developed  in  the  meals  by  cooking. 

Fats  are  less  affected  by  heat  than  proteins  and  carbohydrates.  When 
subjected  to  high  temperatures,  however,  a  portion  at  least  of  the  fat  may 
possibly  undergo  a  partial  decomposition  with  the  liberation  of  free  fatty 
acid(2).  This  explains  why  hot  fat  is  much  more  apt  to  prove  irritating 
to  the  stomach  than  cold  fat,  for  it  is  quite  probable  that  the  fatty  acid 
may  reunite  with  glycerin  to  form  neutral  fat  on  cooling.    Fat  which  has 


PRINCIPLES    OF    SCIENTIFIC    COOKING  53 

been  heated  and  allowed  to  cool  is  often  found  to  have  become  granular 
ill  appearance.  This  change  is  no  doubt  brought  about  by  driving  off 
water,  and  it  tends  to  render  the  fat  more  brittle,  and  consequently  easier 
to  digest.  This  change  is  apparent  to  anyone  who  has  watched  the  "drip- 
ping" or  "rendering"  of  lard,  or  the  process  of  drying  bacon. 

The  great  difference  between  the  French,  English  or  American  cook- 
ing consists  in  the  fact  that  the  French  cook  their  meat  much  longer. 
They  are  therefore  enabled  to  make  a  variety  of  dishes  by  altering  or 
annihilating  the  original  taste  of  the  meat  and  making  it  a  vehicle  for 
foreign  flavors.  The  variety,  daintiness  and, grace  of  form  which  dishes 
thus  acquire  are  very  admirable.  The  French  cook  throws  nothing  away. 
Instead  of  going  to  the  butcher  for  meat  for  stock,  as  the  American  cook 
does,  he  uses  the  trimmings  for  stock  and  the  skimmings  of  his  boiled 
meats  in  many  combinations  where  the  American  uses  butter  or  lard ;  like 
every  skilled  workman,  lio  produces  great  results  from  small  means. 

Changes  Produced  by  Cooking — Efforts  are  being  made  to  teach  cook- 
ing in  the  public  schools,  and  in  this  respect  much  good  work  is  being 
accomplished.  For  any  shortcomings  in  cooking,  however,  the  taste  of  the 
American  is  in  some  measure  accountable.  The  results  of  cooking  food 
are  as  follows : 

(a)  Cooking  develops  certain  savory  flavors  in  food — more  particu- 
larly in  meat — which  are  agreeable  to  the  palate,  and  thereby  enables  man 
to  secure  a  variety  in  taste  which  is  often  important  as  a  stimulus  to  the 
appetite. 

(b)  Cooking  alters  the  consistency  of  food  generally,  making  it  softer. 
Eggs  are  the  exception;  they  become  harder  when  boiled.  Cooking  also 
renders  meat  more  coagulated  and  solid,  more  tender  and  friable,  and 
easier  to  masticate.  This  allows  of  more  free  mixing  of  the  various  di- 
gestive fluids  with  the  food. 

(c)  Cooking  produces  chemical  changes  in  food  which  favor  the  action 
of  the  digestive  enzymes.  This  is  particularly  true  of  some  forms  of 
starch  and  many  varieties  of  meats. 

(d)  Cooking  not  only  sterilizes  the  food  but  destroys  many  varieties 
of  parasites  and  germs  which  may  be  contained  in  the  food  and  which  may 
be  highly  poisonous.  It  has  been  found  that  no  animal  parasite  in  meat 
is  capable  of  withstanding  a  temperature  of  70°  C.  All  ordinary  proc- 
esses of  cooking  will  render  meat  free  from  this  source  of  infection. 

(e)  The  ingestion  of  very  hot  food  is  sometimes  advised  to  favor  the 
digestive  processes,  although  the  importance  of  this  consideration  is  apt 
to  be  exaggerated. 


54  SCIENTIFIC    COOKERY 

(/)  Cooking  improves  the  appearance  of  many  foods,  and  often  pro- 
duces a  delightful  aroma  which  makes  the  morsel  more  appetizing. 

Evil  Effects  of  Poor  Cookery — Good,  wholesome  and  proper  food  mate- 
rials are  often  rendered  valueless  from  poor  cookery.  The  unwholesome- 
ness  of  food  is  quite  as  often  due  to  bad  cookery  as  to  improper  selection 
of  material.  When  scientifically  performed,  cooking  changes  each  of  the 
food  nutrients,  with  the  exception  of  fats,  in  much  the  same  manner  as  do 
the  digestive  juices,  and  at  the  same  time  it  breaks  up  the  food  by  dissolv- 
ing the  soluble  portions  so  that  it  is  more  readily  acted  upon  by  the  chem- 
ical processes  of  digestion.  The  evil  effects  of  bad  cookery  and  the  improper 
selection  of  foods  are  too  numerous  to  mention.  No  doubt  their  ill  effects 
are  as  far  reaching  as  the  use  of  strong  drink ;  indeed,  one  of  the  evils  of 
unwholesome  food  is  its  decided  tendency  to  create  a  craving  for  drink. 
For  bad  cookery  is  the  forerunner  of  indigestion,  which  condition  causes 
thirst,  and  thirst  is  apt  to  produce  and  to  perpetuate  drunkenness.  One 
who  has  suffered  from  a  fit  of  indigestion  and  recalls  the  accompanying 
headache  and  the  lowness  of  spirits,  going  from  dejection  and  ill-humor 
to  extreme  melancholy  with  all  the  mental  faculties  dazed  and  the  normal 
feelings  more  or  less  blunted,  will  hardly  wonder  that  such  a  condition 
may  become  chronic,  which  is  often  the  case  from  the  continued  ingestion 
of  improperly  prepared  foods.  It  is  not  surprising,  then,  that  the  victim 
of  such  circumstances  is  easily  led  to  resort  to  stimulants  to  drown  depres- 
sion and  enliven  spirits. 

VARIETIES    OF    COOKERY 

The  processes  of  cooking  in  common  use  are  as  follows : 
(a)   Boiling  (e)   Roasting 

(&)    Stewing  (/)   Broiling 

(c)  Frying  (g)   Braising 

(d)  Baking  (7^)   Steaming 

There  can  be  no  question  that  there  is  decided  advantage  in  varying 
the  different  methods  of  cooking,  as  well  as  flavoring  the  food,  from  time 
to  time.  Monotony  of  diet  and  the  continued  sameness  of  flavors  are  not 
stimulating  to  the  digestive  organs  or  appealing  to  the  appetite ;  and  when 
conditions  are  such  that  a  variety  of  food  cannot  be  obtained,  variety  in 
their  preparation  can  be  made  to  replace  its  advantages  to  a  great  extent. 
Even  an  epicurean  appreciates  the  effect  on  appetite  of  an  occasional 
change  of  cooks,  or,  if  he  be  a  home  person,  of  an  occasional  meal,  dinner 
or  luncheon  in  a  friend's  home  or  at  a  hotel  or  restaurant.     It  is  not  the 


VARIETIES    OF    COOKEllY  55 

intention  of  the  author  of  this  work  to  discuss  all  the  details  of  the  prepa- 
ration of  foods  for  the  sick,  since  every  trained  nurse  should  be  well 
grounded  in  the  art  of  domestic  science  and  in  invalid  cookery  which 
should  form  the  basis  of  her  education.  We  cannot  hope  to  do  more  than 
explain  the  theory  of  the  chief  methods  of  cooking  and  suggest  occasion- 
ally the  influence  of  scientific  cookery  upon  digestion.  Meats  which  have 
been  twice  cooked  are  undesirable  for  invalids,  as  they  are  apt  to  be  drier 
and  less  nutritious  and  more  difficult  to  digest  than  when  fresh.  For  this 
reason,  when  "hash,"  for  example,  is  twice  cooked,  the  meat  fiber  is  too 
greatly  hardened.  8uch  preparations,  by  the  addition  of  too  much  grease 
and  by  recooking,  are  not  proper  dishes  for  delicate  stomachs ;  for  a  simi- 
lar reason  canned  meats,  wlicu  warmed  over,  are  not  as  easily  digested 
as  fresh  meats,  because  they  have  been  already  cooked  once.  Made-up 
dishes  combining  diiferent  foods  which  recpiire  different  periods  for  their 
cooking  are  undesirable.  Soup,  for  instance,  needs  less  boiling  than  the 
vegetables  added  to  it,  which  should  in  all  cases  be  partially  cooked  alone 
beforehand  so  that  they  will  not  be  underdone.  The  necessary  heat  for 
the  different  varieties  of  cooking  is  obtained  from  many  sources:  from 
wood,  coal,  gas,  oil,  steam,  electricity,  and  of  late  from  the  "fireless 
cooker."  Each  one  of  the  different  methods  possesses  advantages  for  par- 
ticular foods. 

With  these  preliminary  considerations,  we  may  proceed  to  the  study 
of  the  effects  of  cooking  upon  animal  and  vegetable  foods,  respectively. 

COOKING  OF  MEAT 

Boiling. — The  primitive  method  of  boiling  water  originally  consisted 
in  heating  the  water  in  a  hollow  dug-out  in  the  ground  by  plunging  in  red- 
hot  stones  taken  out  of  the  fire.  Later,  as  pottery-making  and  metal- 
working  became  an  art,  cooking  utensils  were  employed.  The  use  of  the 
term  "boiling"  (212°  F.)  in  connection  with  the  (^ooking  of  meat  is  rather 
unfortunate,  for  the  operation  thus  designed,  if  properly  carried  out, 
should  involve  hardly  any  boiling.  The  temperature  should  be  just  suffi- 
cient to  change  the  coloring  matter  of  the  blood,  soften  the  fiber  and  dis- 
solve the  connective  tissue,  which  can  be  successfully  accomplished  by 
water  far  below  its  normal  boiling  point.  Boiling  meat  in  its  strict  sense 
over-coagulates  the  proteins,  dissolves  the  mineral  matter,  and  lowers  the 
caloric  value  of  the  food.  This  is  best  shown  in  a  hard-boiled  eg,g,  in  com- 
parison with  one  cooked  below  the  boiling  point.  Tn  the  former  the  albu- 
min is  rendered  hard  and  indigestible,  and  In  the  latter  the  albumin  is 
soft  and  creamy  and  is  even  more  easily  digested  than  when  raw.    While 


56  SCIENTIFIC    COOKERY 

the  effect  of  over-boiling  meats  is  not  so  apparent  as  in  the  case  of  eggs, 
the  end  results  are  precisely  the  same.  In  the  cooking  of  meat,  however, 
some  boiling  as  a  preliminary  process  of  the  operation  is  necessary,  since 
the  juices  of  meat  are  rich  in  albumin;  it  is  necessary  to  cover  the  meat 
with  boiling,  unsal'ted  water  and  boil  it  rapidly  for  five  minutes  to  coagu- 
late the  albumin  on  the  surface  and  inclose  the  meat  in  a  waterproof  cas- 
ing. This  will  prevent  the  escape  of  the  meat  juices  from  the  interior  of 
the  cut.  The  next  step  is  to  place  the  pot  over  a  moderate  fire  where 
the  temperature  will  be  maintained  at  180°  to  200°  E.,  twenty  minutes 
being  allowed  for  each  pound  of  meat.  If  the  heat  is  not  carried  to  this 
point,  the  interior  of  the  joint  or  piece  of  meat  is  not  perfectly  cooked,  its 
albumin  is  not  sufficiently  coagulated,  and  the  cut  will  have  a  raw  appear- 
ance. If,  on  the  other  hand,  the  actual  boiling  point  is  long  continued,  the 
albumin  will  be  firmly  coagulated  and  the  meat  will  be  tough  and  stringy. 
This  error  in  boiling  meat  is  often  perpetrated  by  incompetent  cooks. 

It  is  a  scientific  fact,  unappreciated  by  many  persons,  that  when  water 
has  once  reached  the  boiling  point,  its  temperature  cannot  be  further  ele- 
vated ;  consequently,  however  hot  the  fire,  or  however  prolonged  the  cook- 
ing, the  temperature  of  the  food  suspended  in  the  boiling  water  cannot  be 
increased  above  that  of  the  boiling  Avater  itself ;  and  the  fact  remains  that 
the  temperature  of  the  interior  of  large  masses  of  food — such  as  a  cut  of 
meat  or  large  potatoes — is  by  no  means  as  great  as  that  of  the  surrounding 
water.  For  this  reason,  it  is  a  mistake  to  pile  on  more  fuel  when  water 
has  once  reached  the  boiling  point,  as  it  will  have  no  further  effect  than 
that  of  accelerating  the  rate  of  ebullition,  without  actually  raising  the 
temperature  of  the  water  or  any  food  immersed  in  it. 

The  concentration  of  broth  or  bouillon  is  dependent  mainly  upon  the 
method  used  in  boiling  the  meat  from  which  it  is  made.  If  the  meat  is 
subjected  to  continuous  boiling  for  an  hour  or  more,  the  connective  tissue 
is  gradually  transformed  into  gelatin  which  in  part  becomes  dissolved 
in  the  water.  A  little  of  the  fat,  melted  by  the  heat  of  the  water  and 
not  being  able  to  mix  with  the  latter,  floats  as  scum  on  the  surface.  In 
addition,  a  small  quantity  of  the  meat  juice  exudes  into  the  surrounding 
liquid,  which  at  this  stage  is  known  as  broth  or  bouillon.  In  order  to 
make  a  very  concentrated  and  nutritious  broth,  the  meat  is  cut  in  fine 
pieces,  put  into  cold  water  and  left  for  a  time.  It  is  then  placed  on  the 
stove  and  slowly  warmed,  although  it  must  not  be  allowed  to  reach  the 
boiling  point.  If  the  temperature  does  not  pass  beyond  160°  F.,  the  meat 
juices  will  be  dissolved  in  the  water.  As  the  water  is  not  hot  enough  to 
coagulate  the  albumin  of  the  meat,  an  increasing  quantity  of  the  con- 


VARIETIES    OF    COOKERY  67 

stituents  of  the  muscle  fibers  passes  out  to  become  dissolved  in  the  broth. 
Such  preparation  gives  to  the  broth  the  natural  flavor  of  the  meat.  The 
ordinary  meat  extracts  are  manufactured  by  allowing  finely  minced  meat 
to  stand  in  cold  vv^ater  for  a  time,  after  which  the  water  is  evaporated 
from  the  ingredients.  If  the  purpose  of  cooking  is  to  leave  as  great  a 
quantity  as  possible  of  the  nutritive  elements  in  the  meat  itself,  a  some- 
what different  process  is  employed.  The  meat  is  quickly  plunged  into 
boiling  water  and  left  there  for  five  minutes.  By  this  method  the  sur- 
face of  the  meat  is  coagulated  sufficiently  to  form  an  effective  barrier 
to  the  passage  of  the  nutritive  juices  from  within.  When  the  cooking  is 
completed,  the  meat  holds  practically  all  of  its  original  nutriment  and 
is  consequently  most  palatable.  On  the  other  hand,  the  broth  contains 
a  minimum  quantity  of  the  meat  juices  in  solution  and  therefore  pos- 
sesses only  slight  food  value. 

The  fact  that  the  coagulation  point  of  a  given  variety  of  albumin 
varies  considerably  must  not  be  overlooked.  Some  albumins  are  coagu- 
lated below  90°  F.  while  others  require  a  heat  of  165°  F. ;  and  since  many 
varieties  of  albumin  occur  in  different  kinds  of  animal  food,  it  will  be 
found  that  they  are  not  all  equally  well  cooked  at  the  same  temperature. 
Parkes  is  the  authority  for  the  statement  that  ammonium  sulphite  is  lib- 
erated by  continued  boiling  and  an  acid  resembling  acetic  acid  is  also 
produced.  Meat  when  plunged  into  boiling  water  has  its  external  layers 
immediately  solidified.  Some  of  the  water  which  they  contain  is  squeezed 
out  into  the  adjacent  fluid  and  an  actual  loss  of  weight  in  meat  occurs, 
ranging  sometimes  as  high  as  30  per  cent.  Williams  is  authority  for  the 
statement  that,  when  salt  is  added  to  water  in  boiling  fish  or  meat,  it  pro- 
duces a  threefold  action:  (a)  It  directly  acts  on  superficial  albumin  with 
a  coagulating  effect;  (h)  it  slightly  raises  the  boiling  point  of  water;  (c) 
by  increasing  the  density  of  the  water,  the  exosmosis  of  the  juices  is  less 
active,  and  hence  the  flavor  is  better  retained.  When  salt  meat  is  to  be 
cooked,  if  steeped  too  long  in  boiling  water,  its  nutritive  properties  are 
impaired,  and  the  muscular  fiber  becomes  hard  and  the  meat  loses  its 
inviting  taste  and  becomes  tough.  In  the  preparation  of  such  a  cut,  it 
would  be  well  first  to  boil  the  meat  less  completely,  and  finish  the  cooking 
by  some  other  method,  either  frying,  roasting  or  broiling. 

Stewing. — Stewing,  or  preparation  en  casserole,  is  in  many  respects 
an  ideal  method  of  cooking  meat.  It  differs  from  boiling  in  that  the  juices 
of  the  meat  are  dissolved  in  the  heated  water,  whereas  in  boiling,  the 
juices  are  prevented  from  passing  out  into  the  water  by  the  coagulation  of 
the  albumin  on  the  outer  surface  of  the  cut.    If  properly  performed,  stew- 


58  SCIENTIFIC    COOKERY 

ing  coagulates  without  over-hardening  the  proteins,  while  owing  to  the 
fact  that  the  juice  is  eaten  together  with  the  meat,  none  of  the  jflavoring 
ingredients  are  lost.  The  proper  temperature  for  stewing  ranges  between 
135°  F.  to  180°  F.  The  prolonged  action  of  heat  and  moisture  converts 
most  of  the  connective  tissue  into  gelatin,  so  that  the  fibers  readily  fall 
apart  and  the  meat  becomes  very  tender.  Here  again,  the  secret  of  success 
is  in  avoiding  too  high  temperature.  It  is  sufficient  to  place  the  pan  on 
the  side  of  the  fire  and  allow  it  to  simmer  only,  instead  of  to  boil.  The 
thermometer  will  show  that  the  temperature  of  simmering  and  boiling 
water  is  practically  the  same,  212°  F.,  the  only  difference  being  that  in 
the  former  case  the  heat  is  reaching  the  water  more  rapidly  and  more  of 
it  is  wasted.     The  proper  temperature  for  scientific  stewing  is  180°  F. 

In  thick  stews,  the  juices  dissolved  in  the  water  are  eaten  together 
with  the  cooked  food ;  but,  when  it  is  desired  to  make  beef  tea  or  other 
kinds  of  soup,  an  aqueous  solution  only  is  used.  It  is  obvious  to  the  reader 
that  the  more  the  food  is  subdivided  the  greater  will  be  the  surface  exposed 
to  the  solvent  action  of  the  water,  and  hence  the  reason  of  mincing  meat 
thoroughly  when  it  is  to  be  used  for  the  preparation  of  beef  tea.  If  such 
minced  meat  has  been  soaked  for  a  long  time  in  cold  water,  a  part  of  its 
albuminous  substances  and  some  of  the  extractive  materials  will  already  be 
in  solution.  But  the  meat  which  is  left  will  be  tasteless,  odorless  and  un- 
palatable ;  in  fact,  animals  fed  upon  such  meat  soon  deteriorate  in  strength. 

The  perfection  of  a  meat  stew  largely  depends  upon  the  thorough  co- 
agulation of  the  outside  juices  and  the  slow  process  by  which  it  is  fin- 
ished, while,  as  before  stated,  the  temperature  should  never  exceed  180°  F. 
Such  flavorings  as  bay-leaf,  onion  and  celery,  pepper  and  salt,  may  be 
added,  but  the  saucepan  should  be  closely  covered  so  as  to  retain  all  the 
flavors.  Stewing  is  a  very  economical  method  of  cooking;  there  is  no 
waste ;  all  escaped  juices  are  held  in  the  solution ;  all  the  nourishment 
is  secured,  and  jf  the  dish  is  well  cooked  and  not  too  greasy,  the  meat  is 
tender  and  readily  digested.  The  difference  between  stewing  and  other 
processes  of  cooking  is  graphically  explained  by  Williams,  who  says :  "In- 
stead of  the  meat  itself  surrounding  and  enveloping  the  juices,  as  it  should 
when  boiled,  roasted,  grilled  or  fried,  we  demand  in  a  stew  that  the  meat 
juices  shall  surround  or  envelop  the  meat." 

Frying — Frying  is  a  process  of  cooking  by  immersion  in  hot  fat  at 
a  temperature  of  from  350°  to  380°  F.,  and  not  by  radiation,  as  in  the 
case  of  broiling  or  roasting.  Since  this  method  of  cooking  is  often  grossly 
misunderstood,  it  requires  some  special  description ;  as  explained  by  Wil- 
liams, "fat  does  not  necessarily  boil,  for  the  food,  as  well  as  the  fatty 


VAIUETIES    OF    COOKERY  59 

material  itself,  may  contain  a  largo  percentage  of  water  which,  by  being 
suddenly  vaporized,  produces  the  familiar  spluttering  which  accompanies 
the  process  of  frying." 

Fats,  when  heated  to  400°  to  500°  F.or  above,  decompose,  yielding  fatty 
acids  and  other  products,  some  of  which  are  volatile.  But  fats  and  oils  used 
in  cooking  do  not  require  a  heat  of  above  400°  F.,  which  will  cause  a  very 
disagTceable  odor  with  much  smoke,  leaving  a  non-volatile  carbon  residue. 

If  a  temperature  not  exceeding  380°  F.  is  maintained,  the  fat  does 
not  smoke  or  decompose.  It  is  chiefly  on  account  of  overheating  that  fried 
foods  are  often  unsightly  and  indigestible.  It  is  difficult  to  regulate  the 
temperature  without  the  aid  of  a  thermometer ;  but  the  following  test  may 
serve  to  indicate  that  the  proper  temperature  is  nearly  reached — a  crumb 
of  bread  dropped  into  a  pan  of  hot  fat  will  turn  brown  in  ten  seconds  if 
the  temperature  has  reached  340°  F. 

Butter  is  not  a  suitable  medium  for  frying,  because  it  rapidly  decom- 
poses at  too  low  a  temperature.  Olive  oil  or  cottonseed  oil  is  far  prefer- 
able. A  mixture  of  oil  and  suet  is  very  good;  but  the  best  medium  for 
frying  purposes  is  a  mixture  of  lard  and  suet.  The  frying  pan  should  be 
sufficiently  deep  to  permit  the  complete  submersion  of  the  article  to  be 
cooked.  The  temperature  of  the  fat  will  at  once  cause  the  formation  on 
the  surface  of  the  article  being  cooked  of  a  complete  covering  through 
which  neither  grease  can  enter  nor  the  juice  escape.  Without  this  im- 
permeable covering,  the  outside  of  the  fried  food  will  be  greasy  and  the 
inside  flavored  with  the  frying  materials,  while  if  proper  precautions  are 
observed,  the  fried  article  will  be  as  free  from  fat  as  if  it  had  been  cooked 
in  water.  With  a  suitable  pan,  and  the  fat  at  the  proper  temperature, 
everything  is  ready  for  "frving,"  and  the  article  should  be  plunged  into 
the  fat  and  left  for  two  or  three  minutes.  The  spluttering  which  follows 
is  due  to  the  sudden  conversion  of  the  moisture  on  the  surface  of  the  food 
into  steam ;  when  this  has  ceased,  the  cooking  is  complete  and  the  food 
should  be  instantly  removed  and  allowed  to  drain  on  paper,  to  remove  all 
traces  of  fat.  It  will  be  observed  that  the  process  is  entirely  different 
from  the  so-called  frv'ing  usually  practiced  in  well-regulated  homes,  in 
which  a  little  fat  is  employed  merely  to  prevent  the  food  from  adhering 
to  the  frying  pan — an  abbreviated  form  of  roasting  really  being  per- 
formed. Frying,  after  all,  is  less  perfectly  understood  by  the  ordinary 
cook  than  almost  any  other  process  of  cooking  meat,  and,  as  usually  car- 
ried out,  results  in  abominably  prepared  and  unwholesome  food.  The 
pans  are  not  deep  enough  and  the  food  and  fat  are  scorched  and  rendered 
unpalatable  and  quite  indigestible. 


60  SCIENTIFIC    COOKERY 

Eaking. — Baking  is  a  process  of  cooking  meat  in  the  dry  heat  of  an 
oven.  The  oven  of  the  stove  generally  receives  its  heat  from  the  fire-box, 
although  in  large  establishments  it  is  heated  by  steam  under  pressure. 
No  matter  how  great  the  surrounding  heat,  a  thermometer  placed  in  the 
center  of  the  cut  or  joint  will  scarcely  register  200°  F.,  the  meat  being 
really  cooked  in  its  own  juice  at  a  gentle  heat. 

This  method  of  cooking  meat — in  a  confined  space — prevents  the  vola- 
tile products  from  escaping,  as  in  roasting,  and  in  consequence,  the  meat 
has  a  somewhat  stronger  and  less  delicate  flavor  than  when  roasted ;  it  is 
also  richer,  and  therefore  more  liable  to  disagree  with  persons  of  dyspeptic 
tendencies.  This  process  of  cooking  causes  the  cut  or  joint  to  become  satu- 
rated with  empyreumatic  oils — unless  its  surface  is  protected  by  a  pie 
crust,  as  in  the  case  of  "pot  pie"  or  "chicken  pie" — but  even  that  does  not 
add  to  its  digestibility. 

Certain  mechanical  and  chemical  changes  take  place  during  the  process 
of  baking;  considerable  moisture  is  driven  off,  therefore  baked  foods  are 
drier  when  cooked  than  before  cooking;  heat  and  moisture  present  in  the 
foods  cause  a  rupture  of  the  cell  walls.  In  this  way  the  proteins  are  coag- 
ulated, and  possibly  other  changes  in  the  texture  and  consistency  of  the 
foods  are  produced.  The  chemical  changes  brought  about  are  as  follows : 
Proteins  are  coagulated,  fats  are  more  or  less  broken  down  into  simpler 
bodies,  and  carbohydrates  on  the  surface  especially  are  to  a  greater  or 
lesser  extent  caramelized. 

Baking  with  dry  heat — food  confined  in  a  closed  oven — may  be  termed 
a  slow  process  of  cooking,  and  it  is  interesting  to  learn  that  the  advantages 
of  slow  cooking  are  not  altogether  unknown  to  some  savage  tribes.  In 
this  respect  the  civilized  cook  may  learn  something  from  their  crude 
methods.  Mr.  F.  T.  Bullen(3)  describes  as  follows  the  process  of  baking 
meat  as  practiced  by  the  Kanakas  of  the  Friendly  Islands,  and  we  doubt 
if  any  better  illustration  of  the  advantages  of  slow  cooking  can  be  found : 

A  hole  is  scooped  in  the  earth,  in  which  a  wood  fire  is  made  and  kept  burn- 
ing until  a  fair-sized  heap  of  glowing  charcoal  remains.  Pebbles  are  then  thrown 
in  until  the  live  coals  are  covered.  Whatever  is  to  be  cooked  is  enveloped 
in  leaves,  placed  upon  the  pebbles,  and  more  leaves  heaped  upon  it.  The  earth 
is  then  thrown  back  into  the  cavity  and  well  stamped  down.  A  long  time  is,  of 
course,  needed  for  the  viands  to  get  cooked  through,  but  so  subtle  is  the  mode,  that 
overdoing  anything  is  almost  an  impossibility.  A  couple  of  days  may  pass  from 
the  time  of  "putting  down"  the  joint,  yet  when  it  is  dug  up  it  will  be  smoking 
hot,  retaining  all  its  juices  tender  as  jelly  but,  withal,  as  full  of  flavor  as  it  is 
possible  for  cooked  meat  to  be.  No  matter  how  large  the  joint  is  or  how  tough 
the  meat,  this  gentle  suasion  will  render  it  succulent  and  tasty;  and  no  form  of 
civilized  cookery  can  in  the  least  compare  with  it. 


VAKIETIES    OF    COOKERY  61 

The  baking  of  bread  is  considered  with  the  cooking  of  vegetables,  in 
Volume  I,  Chapter  XIII,  page  365. 

Roasting — Itoasting  is  a  process  of  cooking  meat,  in  which  heat  is 
conveyed  by  direct  radiation,  in  a  closed  oven  instead  of  through  the 
medium  of  water (4).  The  terms  broiling,  grilling  and  roasting  denote 
the  same  operation.  The  first  two  are  used  to  designate  the  process  when 
applied  to  steaks  or  smaller  pieces  of  meat;  the  term  "roasting"  is  used 
when  a  "large  joint"  or  "rib  roast"  is  cooked.  In  the  process  of  roasting 
there  is  considerable  loss,  especially  if  the  joint  be  a  fat  one,  but  the  flavor 
is  incomparably  finer  than  if  baked  or  boiled.  Roasting  of  large  joints  of 
meat  and  of  fowls  is  perhaps  best  done  by  hanging  the  article  to  be  roasted 
on  a  spit  which  slowly  revolves  in  front  of  and  in  close  proximity  to  a 
clear  and  quick  burning  coal  fire.  In  large  restaurants  this  is  the  process 
generally  followed. 

For  the  proper  roasting  of  a  joint,  much  care  is  necessary  to  avoid  • 
excessive  heat  except  for  a  period  of  five  minutes  (175°  F.),  in  which 
the  coagulated  albumin  will  completely  seal  up  and  cover  over  the  exter- 
nal surface  of  the  meat ;  for  the  same  reason  as  in  boiling,  the  temperature 
should  then  be  slightly  lowered.  The  process  of  cooking  meat  in  this 
manner  is  somewhat  analogous  to  that  of  stewing;  in  fact,  the  interior  por- 
tions of  the  meat  are  "stewed  in  its  own  juices"  instead  of  water. 

The  outer  coating  prevents  the  evaporation  of  the  juices  of  the  meat 
which,  together  with  the  extractive  materials,  add  flavor  to  the  roast. 
Roasted  meat  has  a  decided  advantage  in  flavor  as  well  as  nutritive  value 
over  meat  which  has  been  boiled  for  a  long  time,  although  the  latter  may 
be  more  tender  and  more  easily  digested. 

The  high  temperature  suddenly  applied  in  roasting  meat  produces  a 
firmer  coagulation  on  the  external  surface  of  the  joint  than  occurs  in  boil- 
ing— by  which  process  more  of  the  natural  juices  are  retained.  "If  the 
principles  of  scientific  roasting  are  carefully  observed,"  says  Williams(5), 
"the  meat  should  be  cooked  by  the  action  of  radiant  heat  projected  towards 
it  from  all  sides  while  it  is  immersed  in  an  atmosphere  nearly  saturated 
with  its  own  vapor." 

The  proper  roasting  of  meat  or  fowl  cannot  be  accomplished  without 
the  efl^usiou  of  more  or  less  of  the  meat  juices  and  the  melting  of  a  small 
portion  of  the  superficial  fat  and  of  gelatin.  These  substances  in  solution 
form  the  "meat  gravy,"  which  is  ouite  savory  and  very  nutritious,  and 
which  a  good  cook  advantageously  uses  for  "basting"  the  roast  to  prevent 
drying,  and  to  distribute  the  heat  more  uniformly  over  the  surface.  The 
process  of  roasting,  if  correctly  performed,  not  only  prevents  the  escape  of 


62  SCIENTIFIC    COOKEKY 

the  natural  meat  flavors,  but  develops  in  it  substances  which  are  them- 
selves of  a  sapid  savory  nature.  These  savory  substances  result  from 
changes  produced  by  the  action  of  the  heat  on  the  extractives  on  the  sur- 
face of  the  meat  somewhat  analogous  to  the  alteration  which  sugar  under- 
goes in  its  conversion  into  caramel.  The  action  of  high  temperature  on 
these  substances  produces  a  dark  brown,  sticky  substance  on  the  surface 
of  the  fowl,  roast  or  joint  which  is  familiar  to  everyone.  This  is  sometimes 
called  osmozone  and  is  one  of  the  most  tasty  and  sapid  substances  known. 

Meat  which  by  accident  has  become  "over-roasted"  or  burned,  will 
present  scorched  or  charred  surfaces,  due  largely  to  the  carbonizing  of  the 
fat.  Before  the  fat  has  become  completely  burned,  certain  volatile  fatty 
acids  are  liberated  which  emit  a  very  disagreeable  odor;  besides,  other 
products  are  developed  which  are  of  no  nutritive  value,  but  which  may  be 
positively  irritating  to  the  alimentary  canal. 

For  the  proper  roasting  of  beef,  mutton  and  game,  according  to  Yeo, 
a  temperature  of  135°  F.  is  sufficient,  and  the  meat  is  "rare"  and  "under- 
done," retaining  a  good  deal  of  its  reddish  color;  but  veal  and  poultry 
should  be  roasted  at  a  higher  temperature — from  150°  to  160°  F.  These 
temperatures  are  slightly  lower  than  often  recommended,  and  are  intended 
as  the  degrees  to  be  maintained  after  the  meat  is  placed  in  position  and 
has  had  the  first  five  minutes  of  excessive  heat  previously  mentioned.  It 
is  interesting  and  at  the  same  time  important  to  remember  that  the  smaller 
the  cut  to  be  roasted  the  hotter  should  be  the  fire.  An  intensely  hot  fire 
coagulates  the  exterior  and  prevents  the  drying  up  of  the  meat  juices. 
This  method  would  not,  however,  be  applicable  to  large  cuts,  because  meats 
are  poor  conductors  of  heat,  and  a  large  piece  of  meat  exposed  to  this 
intense  heat  would  become  burned  and  changed  to  charcoal  on  the  exterior 
long  before  the  heat  could  penetrate  to  the  interior.  Hence  the  rule :  the 
smaller  the  cut  to  be  roasted,  the  higher  the  temperature  to  which  it  should 
be  exposed. 

Game  or  meat  which  is  'Tiigh"  or  slightly  tainted,  if  cooked  by  boiling 
or  stewing  becomes  extremely  repulsive  and  the  odors  from  it  exceedingly 
offensive.  It  disintegrates  more  rapidly  and  the  elements  of  decomposi- 
tion pass  into  and  flavor  the  whole  mass.  Such  meat  may  be  made  more 
or  less  palatable,  and  sometimes  wholesome,  by  roasting,  when  the  external 
layers  which  have  commenced  to  decompose  are  thoroughly  browned  and 
thereby  disinfected,  though  repulsive  putrefactive  odors  will  be  noticed. 
As  pointed  out  in  the  chapter  on  Animal  Foods,  "high  game"  is  in  a  putre- 
factive stage — a  condition  produced  by  certain  microorganisms  or  bacteria 
which  are  constantly  floating  in  the  atmosphere,  in  search  for  a  convenient 


VARIETIES    OF    COOKERY  63 

place  of  living  and  breeding,  and  wliicli  find  the  juices  of  flesh  ideal  for 
their  purposes.  The  period  of  time  required  for  a  piece  of  meat,  game  or 
fowl  to  hang,  in  order  to  obtain  tlie  proper  game  flavor,  depends  some- 
what upon  the  season  of  the  year,  the  temperature  and  the  climatic  condi- 
tions; and  the  boundary  line  between  the  "gamy  flavor"  and  the  stage  of 
putrefaction  is  very  narrow  and  easily  passed  without  recognition. 

The  game  flavor  is  due  to  the  metabolic  activity  of  the  micro- 
organisms which  have  settled  upon  the  meat,  and  which,  by  a  process  al- 
lied to  that  of  fermentation,  produce  changes  in  the  albumin  and  other 
constituents,  giving  rise  to  certain  aromatic  bodies.  These  microorganisms 
of  putrefaction  produce  an  enzyme  which,  in  coming  in  contact  with  the 
albuminous  portions  of  the  flesh,  may  so  act  as  to  produce  poisonous  sub- 
stances known  as  ptomains  and  leukomains.  Game  that  is  "high,"  or 
meats  which  are  tainted,  though  apparently  well  cooked,  are  liable  to  pro- 
duce ptomain  poisoning.  The  heat  employed  in  the  process  of  cooking 
destroys  the  bacteria  in  the  meat,  and  it  may  be  safely  eaten  while  it  is 
hot ;  but  the  heat  may  not  have  been  sufficient  to  destroy  the  enzyme  of 
such  bacteria — which  goes  on  destroying  albumin,  with  the  production 
of  ptomains  or  leukomains  even  after  cooking.  It  may  thus  happen  that 
a  portion  of  tainted  meat  is  sometimes  partaken  of  quite  freely  and  with 
impunity  immediately  after  it  is  cooked,  but  a  few  hours  later,  ptomains 
having  then  been  produced  by  the  enzymes,  it  becomes  very  poisonous. 
Some  epicures  prefer  to  have  a  leg  of  mutton  or  a  piece  of  game  hung 
until  the  process  of  decomposition  is  noticeable  and  the  tainted  odors  pres- 
ent, but  meat  to  be  cooked  by  boiling  must  under  all  conditions  be  abso- 
lutely  fresh. 

Broiling. — Broiling  or  grilling  is  a  means  of  quick  cooking,  requiring 
much  less  time  than  roasting  or  boiling,  because  intense  heat  is  applied  to 
comparatively  small  pieces  of  meat.  The  object  in  broiling  is  to  raise  the 
temperature  of  the  interior  of  the  meat  quickly  to  180°  F.,  so  that  the 
moisture  contained  in  it  will  not  have  time  to  evaporate.  For  successful 
broiling,  therefore,  it  is  necessary  to  have  the  meat  as  close  as  possible  to 
the  glowing  coals  to  increase  the  radiation  and  to  limit  the  retarding 
effects  of  air  currents.  It  is  for  this  reason  that  steaks  and  chops  cooked 
in  restaurants  or  hotels  are  often  better  than  those  cooked  in  the  home, 
where  one  cannot  have  the  specially  designed  grills  or  revolving  spits 
which  bring  the  meat  in  close  contact  with  the  radiant  surface  of  the  glow- 
ing fire. 

In  broiling  steak,  the  meat  should  first  be  placed  over  a  clear,  hot  fire 
until  one  side  is  seared ;  then  it  should  be  turned  and  the  other  side  seared 


64  SCIENTIFIC    COOKERY 

in  like  manner.  The  steak  should  now  be  placed  at  a  greater  distance  from 
the  fire  and  the  cooking  thus  continued  at  a  lower  temperature,  five  minutes 
being  allowed  for  a  steak  one  inch  thick,  if  liked  rare,  and  eight  minutes 
if  preferred  well  done.  A  steak  one  and  a  half  inches  thick  requires  from 
eight  to'ten  minutes,  and  a  steak  two  inches  thick  twenty  minutes.  Sea- 
soning may  be  added  after  the  steak  has  been  cooked.  A  favorite  season- 
ing for  steak  is  maitre  d'hotel  butter  (1/4  cup  of  butter,  1  teaspoonful  of 
salt,  l^  saltspoon  of  pepper,  1  tablespoonful  of  chopped  parsley  and  1 
tablespoonful  of  lemon  juice).  A  properly  broiled  steak  or  chop  is  thick- 
ened in  the  center,  but  if  badly  grilled  it  is  thin  and  dry.  It  should  not 
be  overlooked  that  the  evaporation  in  broiling  depends  upon  the  extent 
of  the  surface  of  the  meat,  and  for  this  reason  thinly  cut  steaks  or  chops 
become  comparatively  dry  and  shriveled  in  the  center. 

Roasting  and  broiling  are  the  most  universal  methods  of  cooking  meat. 
The  savage  or  hunter  requires  no  utensils  for  cooking  his  game,  but  for 
boiling  it  is  necessary  to  have  vessels  in  which  to  place  the  food.  The 
Polynesian  cooks  his  meat  by  roasting  it  on  a  hot  stone,  and  sprinkles  it 
with  sea  water  to  obtain  the  salt.  The  primitive  hunter  incases  his  meat 
or  fowl,  skin  and  all,  in  damp  clay  and  bakes  it  by  surrounding  it  with 
hot  coals.  The  Australian  savage,  the  lowest  type  of  man,  does  all  his 
cooking  by  roasting. 

Braising — Braising  is  a  process  of  cooking  intermediate  between  boil- 
ing and  baking.  First  the  meat  is  partially  browned  and  cooked  in  a 
moist  heat  in  a  vessel  with  a  close  fitting  lid.  Some  of  the  so-called  "roast- 
ing pans"  or  "braising  pots"  are  suitable  for  this  purpose.  The  meat 
should  be  placed  in  a  pot  or  pan  and  partially  covered  with  hot  "stock" 
or  water  composed  of  a  solution  of  animal  and  vegetable  juices  called 
"braise."  Seasoning  such  as  bay-leaf,  onion,  celery  seed,  etc.,  should  be 
added  and  the  pan  closely  covered.  Cooking  should  be  done  in  a  hot  oven 
in  which  the  meat  is  exposed  to  a  strong  but  not  boiling  temperature,  15 
minutes  being  allowed  for  each  pound  of  meat.  Sherry  or  some  spices 
may  be  added,  such  as  cloves  or  mace;  salt  and  pepper  should  be  added 
when  the  meat  is  about  half  done.  The  cover  of  the  vessel  should  be  re- 
moved half  an  hour  before  serving  and  the  stock  reduced  so  that  it  can 
be  served  as  a  sauce.  The  amount  of  sauce  allowed  to  remain  should  be 
barely  sufficient  to  cover  the  meat,  and  in  this  way  the  surrounding  broth 
is  kept  highly  concentrated.  Braising  is  an  economical  process  of  cook- 
ing; the  constituents  lost  by  the  meat  from  evaporation  and  solution  are 
absorbed  almost  entirely  by  the  gravy.  This  process  of  cooking  is  espe- 
cially valuable  in  cooking  tough  meat  or  any  kind  of  meat  which  is  too 


VARIETIES    OF    COOKERY 


65 


fresh  or  young.  It  is  best  adapted  to  the  so-called  inferior  pieces,  as  a  leg 
of  mutton,  the  npper  and  under  round,  and  the  fleshy  part  of  the  shoulder. 
Steaming — Steaming  as  a  process  of  cooking  meat  is  but  little  used 
and  is  mainly  applied  to  cooking  cereals,  puddings,  etc.  Steamed  foods, 
as  a  rule,  are  more  highly  flavored  than  those  boiled,  for  the  reason  that 
in  steaming,  the  soluble  constituents  are  not  so  easily  lost  as  in  boiling. 
The  process  of  steaming  can  be  carried  out  in  a  "modern  steam  cooker" 
or  in  a  perforated  kettle  which  fits  closely  over  another  kettle  containing 
boiling  water.  If  the  steam  is  under  pressure,  the  temperature  may  be 
much  higher  than  that  of  boiling  water,  and  hence  the  method  may  be 
used  for  sterilizing  canned  foods.  In  large  establishments  such  as  hotels, 
restaurants  and  clubs,  the  method  is  also  used  for  the  baking  of  meats. 
Ordinary  home  steaming  is  an  excellent  method  of  cooking  vegetables, 
hams,  fruit  cakes,  puddings  and  other  dishes  that  require  the  prolonged 
application  of  moist  heat. 

LOSSES  IN  COOKING  MEAT 

It  has  been  determined  by  Johnston  that,  no  matter  how  carefully  or 
by  what  process  meat  is  cooked,  there  is  always  a  certain  amount  of  loss 
of  the  soluble  constituents,  for  instance: 


In  Boiling 

In  Baking 

In  Roasting 

4  lbs.  of  beef  loss  in  weight 

lib. 

1  lb.  3  oz. 

1  lb.  5  oz. 

4    "     mutton"    "       " 

14  oz. 

1  lb.  4  oz. 

1  lb.  6  oz. 

The  greater  part  of  this  loss  is  water,  shown  by  the  following  analysis 
given  by  Konig : 


COMPARATIVE   COMPOSITION   OF   MEATS   BEFORE   AND   AFTER 

COOKING 


Nitroge- 

Extrac- 

Water, 

nous 

Fat, 

tive 

Salts, 

Per  cent 

Matter, 
Per  cent 

Per  cent 

Matter, 
Per  cent 

Per  cent 

Beef: 

Before  cooking;  (raw) .  . 

70.88 

25.51 

4.52 

.86 

1.23 

Same  after  boiling 

56.82 

34.13 

7.50 

.40 

1.15 

Same  after  broiling  (as 

beefsteak) 

55.39 

34.23 

8.21 

.72 

1.45 

Veal  Cutlets: 

Before  roasting  (raw) . . 

71.55 

20.24 

6.38 

.68 

1.15 

Same  after  roasting. . .  . 

57.59 

29.00 

11.95 

.03 

1.43 

66 


SCIENTIFIC    COOKERY 


The  actual  loss  of  the  soluble  matter  is  more  clearly  stated  iu  Bulletin 
No.  21,  United  States •  Department  of  Agriculture.  The  estimate  below 
is  calculated  on  the  basis  of  dry  substances : 

COMPARATIVE  COMPOSITION  OF  WATER-FREE  SUBSTANCE  OF 
MEATS  BEFORE  AND  AFTER  COOKING 


Nitrogen, 
Per  cent 


Protein, 
Per  cent 


Fat, 
Per  cent 


Extractive 
Matter, 
Per  cent 


Salts, 
Per  cent 


Beef: 

Before  cooking 

After  boiling. . 

After  roasting. 
Veal  Cutlets: 

After  cooking. 

After  roasting. 


12.37 
12.65 
12.27 

11.39 
10.93 


77.31 
79.06 
76.73 

71.17 
68.36 


15.47 
17.38 
18.41 

22.45 

28.18 


2.98 

.90 

1.59 

2.32 
.09 


4.24 
2.66 
3.27 

4.06 
3.37 


A  careful  study  of  these  figures  proves  that  the  loss  is  almost  entirely 
confined  to  the  extractive  matter  and  salts  of  the  meat. 


COOKING  OF  FISH 

Fish  may  be  cooked  by  boiling,  grilling,  baking,  frying  or  stewing. 
Of  these  several  processes  boiling  is  decidedly  the  most  advantageous  for 
persons  with  feeble  digestions,  and  next  in  order  is  broiling.  The  flavor- 
ing ingredients  of  fish  are  more  readily  dissolved  by  water  than  those  of 
meat,  and  since  fish  has  less  flavor,  in  the  first  instance,  any  loss  in  this 
direction  is  to  be  carefully  guarded  against.  For  this  reason,  boiling,  un- 
less most  carefully  supervised,  is  not  a  suitable  method  of  cooking  fish. 
Even  when  carefully  performed,  the  loss  exceeds  5  per  cent  of  solid  mat- 
ter, and  on  this  account,  cooking  by  means  of  steaming  is  preferable  just 
as  in  the  case  of  some  vegetables.  When  fish  is  boiled  without  the  addition 
of  salt  to  the  water,  it  becomes  soft  and  disintegrates,  but  if  boiled  in  sea 
water  or  ordinary  water  to  which  salt  has  been  added,  the  fish  maintains 
its  shape  and  flavor.  The  quantity  of  salt  regulates  the  osmosis  of  the 
juices  of  the  fish  into  the  water. 

As  a  iiile,  fish  is  cooked  in  much  less  time  than  meat.  If  fried  fish 
is  to  be  eaten  by  persons  of  dyspeptic  tendencies,  it  should  be  cooked 
whole  and  the  skin  carefully  removed  subsequently.  But  fried  fish  is 
never  as  easily  digested  as  boiled  fish.  The  essential  principle  of  frying 
fish  consists  in  the  sudden  exposure  of  the  object  to  be  cooked  to  a  very 
high  temperature,  which,  as  we  have  seen  in  the  section  on  frying,  has 
the  effect  of  producing  an  instantaneous  coagulation  of  the  albuminoid 


VARIETIES    OF    COOKERY  67 

matter  on  tlie  surface,  together  with  a  slight  degree  of  charring,  thus 
preventing  tiio  escape  of  juices  and  other  soluble  substances,  while  the 
surrounding  temperature  is  so  high  that  the  fish  is  practically  cooked 
through  its  whole  thickness  almost  instantaneously. 

In  order  to  attain  the  proper  temperature  for  frying  fish,  olive  or  good 
cottonseed  oil  is  the  best  medium.  A  deep  pan  is  necessary,  and  a  tem- 
perature of  from  350°  to  390°  F.  When  this  temperature  has  been 
reached,  the  fish  should  be  suddenly  plunged  into  the  pan  and  left  for 
2  or  3  minutes.  Considerable  spluttering  will  immediately  ensue,  and 
when  it  ceases,  the  cooking  \v\\\  be  complete. 

COOKING  OF  VEGETABLE  FOODS 

The  objects  to  be  achieved  in  cooking  of  vegetable  foods  are  somewhat 
the  same  as  in  cooking  animal  foods,  namely,  to  render  them  more  diges- 
tible, to  give  variety,  to  modify  their  flavor  and  in  some  cases  to  preserve 
them.  While  it  is  possible  but  not  practicable  to  eat  animal  foods  without 
cooking,  yet  it  is  impossible  to  eat  certain  vegetable  foods  in  a  raw  state, 
as  man  is  almost  incapable  of  digesting  the  cellulose  framework  of  vege- 
table foods;  hence,  cooking  in  order  to  soften  this  cellulose  framework, 
and  to  bring  about  a  gelatinization  of  its  starch,  are  the  ends  to  be  desired 
in  cooking  vegetables.  Cellulose,  as  we  found  when  studying  vegetable 
foods,  is  a  very  hard,  indigestible  substance  in  its  raw  state,  or  until  it 
has  been  partly  converted  into  sugar  by  the  action  of  acids,  aided  by  heat. 
It  is  probable  that  this  change  does  not  ordinarily  take  place  in  cooking 
or  in  digestion.  In  ripening  fruits  such  change  is  due  to  enzyme  action. 
In  its  unripe  state,  a  pear  or  other  fruit  is  very  hard  and  "woody,"  due 
to  the  presence  of  this  cellular  framework.  In  the  process  of  ripening, 
the  acids  of  the  fruit,  aided  by  the  heat  of  the  sun,  bring  about  a  soften- 
ing of  this  framework  with  partial  or  more  or  less  complete  solution  of 
the  cellulose  fibers,  producing,  when  ripened,  a  sweet,  soft  fruit. 

In  the  cooking  of  vegetables  the  cellulose  envelopes  are  burst  asunder 
in  consequence  of  the  heat,  so  that  when  ingested,  the  digestive  ferments  of 
the  alimentary  canal  have  more  ready  access  to  the  starchy  or  albuminous 
contents.  In  bread  and  other  glutinous  foods,  the  albumin  is  coagulated, 
and  in  the  case  of  bread,  it  sets  in  a  permanent  vesicular  mass  which  the 
digestive  secretions  readily  permeate  and  attack.  In  the  cooking  of  green 
vegetables,  the  fibers  are  softened,  the  albumin  coagulated,  the  gummy, 
saccharine,  saline  and  oily  matters  are,  to  a  more  or  less  extent,  partially 
removed  by  the  water.  It  should  be  unnecessary  to  state  here  that  all 
vegetables  need  thorough   washing  before  cooking.     Roots   and  tubers, 


68 


SCIENTIFIC    COOKEKY 


especially,  should  be  well  cleaned  before  paring.  As  a  general  rule,  all 
vegetables  to  be  boiled  or  stewed  should  be  cooked  rapidly  with  just  enough 
water  to  prevent  burning  and  with  the  lid  oif  the  saucepan;  the  rising 
scum  should  be  frequently  removed.  Rain  water  is  especially  adapted  for 
cooking  on  account  of  its  softness  and  freedom  from  salts  of  lime  and 
magnesia.  These  salts  are  present  in  hard  water,  and  when  vegetables  or 
meat  are  boiled  in  it,  a  certain  amount  of  salts  is  deposited,  thereby  in- 
creasing the  scum.  Wlien  these  salts  are  deposited  upon  the  meat  or  vege- 
tables, they  hinder  the  penetration  of  heat  into  the  interior,  and  so  their 
presence  may  prevent  the  abstraction  of  soluble  materials  when  it  is  de- 
sired to  make  broth  or  soup. 


GAIN  OF  WATER 

ON  COOKING  VEGETABLES 

Per  cent  of 

Water  in 

Raw  State 

Per  cent  of 

Water  after 

Cooking 

Increase 

Parsnips 

82.0 
80.0 
89.0 
90.0 
90.8 
93.3 
94.8 

97.2 
91.6 
97.5 
98.0 
96.4 
97.9 
99.1 

15.2 

Artichokes 

11.6 

Cabbage 

8.5 

Spinach 

8.0 

CauUflower 

5.6 

Sea-kale 

4.6 

Vegetable  marrow 

4.3 

Some  coarse,  raw  vegetables — principally  the  roots  and  tubers,  such  as 
turnips,  carrots,  beets  and  potatoes — while  they  make  good  food  in  the 
raw  state  for  animals,  are  unpalatable  and  indigestible  for  man,  and  re- 
quire softening  and  alteration  by  prolonged  boiling  in  water  or  some  other 
form  of  cooking.  The  action  of  heat  through  boiling  macerates  the  cellu- 
lar fibers  or  walls  of  the  cells,  softens  their  contents  and  renders  the  vege- 
tables more  easily  masticated,  while  the  effect  of  the  heat,  together  with 
the  accompanying  moisture,  causes  swelling  and  rupturing  of  the  starch 
grains,  in  which  condition  the  vegetable  matter  is  more  easily  and 
promptly  acted  upon  by  the  starch  digesting  enz\Tnes  contained  in  the 
saliva  and  pancreatic  juice.  Many  vegetables  are  better  steamed  than 
boiled,  as,  for  instance,  potatoes,  rice,  young  peas,  corn,  squash,  cucum- 
bers, pumpkins  and  spinach.  The  effect  of  cooking  upon  green  vegetables, 
in  some  instances,  is  to  decrease  their  already  poor  stock  of  nutrients. 
They  gain  water  and  lose  part  of  their  carbohydrate  and  protein  content, 
much  of  their  mineral  matter  and  nearly  all  of  their  non-albuminoid 
nitrogenous  constituents.     For  example,  in  cooking  cabbage  by  boiling, 


VARIETIES    OF   COOKERY  69 

more  than  30  per  cent  of  its  total  solids  is  lost,  as  well  as  a  large  amount 
of  the  total  mineral  matter,  and  one-third  of  the  carbohydrate,  all  of  the 
non-protein  nitrogen,  and  5  per  cent  of  the  protein.  Some  of  the  com- 
moner vegetables  gain  a  large  percentage  of  water  in  cooking,  as  shown 
in  the  table  on  the  opposite  page(6)  : 

We  append  below  a  table (7)  showing  the  amount  of  carbohydrates 
contained  in  some  of  the  commoner  vegetables  before  and  after  cooking : 

After  Boiling 

Raw  and  Straining 

Per  cent  Per  cent 

Cabbage,  turnip  (young) 3.09  2.43 

Cauliflower 2.10  1.40 

Spinach 2.97  .85 

Winter  cabbage 6.75  3.20 

Asparagus ....  1.6 

Savoys 2.7  .... 

The  deficiency  of  fat  in  vegetables  is  often  made  up  by  the  addition 
of  butter  or  oil  in  the  course  of  preparation  for  the  table.  Vegetables 
prepared  in  this  way  may  be  made  an  important  vehicle  for  conveying  fat 
into  the  body.  The  amount  of  fat  which  some  vegetables  can  readily  take 
up  without  being  overloaded  is  shown  in  the  following  table: 

100  parts  of  potato  pur^e can  take  up         50  parts  of  fat 

100  "      "  boiled  potato "  "  "  40-50      "      "     " 

100  «      "  baked       "      "  "  "  40-50     "      "    « 

100  "      «  red  cabbage «  "  "  40 

100  «      "  savoy  cabbage «  "  "  32 

100  "      "  cabbage  lettuce «  «  «  24 

100  "      «  potato  souffle «  «  «  20 

100  "      "  fried  potatoes «  «  «  15 


«  a  u 

u  u  a 

u  u  u 

a  u  u 

u  u  u 


Vegetables  are  not,  on  the  whole,  readily  digested.  It  has  been  shown 
that  five  and  one-third  ounces  of  cabbage  require  three  hours.  The  same 
amount  of  cauliflower  requires  only  two  and  one-half  hours.  Certain  vege- 
tables are  difficult  to  deal  with  in  the  intestine  owing  to  their  bulk  and 
the  amount  of  cellulose  which  they  contain.  If  they  are  slightly  stale, 
their  presence  in  the  intestines  causes  fermentation  with  the  generation 
of  gases  due  to  the  action  of  the  organisms  on  the  cellulose.  The  action 
of  heat  on  the  protein  contained  in  vegetables  has  an  effect  similar  to  that 
which  it  exerts  on  the  same  constituent  of  animal  food;  the  coagulation  of 
protein  produces  a  shrinkage  rather  than  a  swelling  of  the  food,  and  for 
this  reason,  if  the  cellulose  framework  encloses  protein  only,  it  does  not 
rupture.  One  can  readily  understand,  therefore,  that  if  a  vegetable  food 
contniuod  only  protein,  its  digestibility  would  not  be  increased  by  cooking, 
but  rather  decreased.     As  a  matter  of  fact,  however,  there  are  few  vege- 


70  SCIENTIFIC    COOKERY 

table  foods  which  do  uot  contain  iniich  starch  together  with  the  protein, 
and  hence  it  is  that  the  general  rule  holds  good,  that  cooking  increases 
the  digestibility  of  all  vegetable  foods. 

FOOD    CONCENTRATION 

Eood  concentration  is  based  upon  the  fact  that  the  large  percentage  of 
free  water  contained  in  some  foods  can  be  removed  by  evaporation.  This 
process  reduces  the  weight  and  at  the  same  time  the  bulk  of  the  food.  Fur- 
ther condensation  may  be  accomplished  by  pressure  with  hydraulic  ma- 
chinery applying  several  tons  of  force  to  the  square  inch. 

Desiccation. — Desiccation  involves  the  removing  of  more  water  from 
foods  than  can  be  removed  by  evaporation  alone.  Such  food  products  are 
commonly  refered  to  as  "condensed."  Desiccation  may  be  carried  to  the 
point  where  the  food  is  entirely  dry,  in  which  case  the  substance  "desic- 
cated" may  be  torn  into  shreds  or  pulverized.  Condensed  and  powdered 
fcods  are  usually  added  to  other  foods  in  order  to  thicken  them  or  add  to 
their  nutritive  properties.  Desiccated  meat  is  the  most  concentrated  form 
of  protein,  sugar  is  the  most  concentrated  form  of  carbohydrate,  and  olive 
oil  is  the  most  concentrated  form  of  fat. 

Concentrated  Proteins. — Concentrated  proteins  are  prepared  from  milk, 
meat,  eggs  and  vegetables.  Meat  is  concentrated  by  drying,  and  in  this 
form  is  practically  indigestible.  This  indigestibility  can,  however,  be 
overcome  by  predigestion  or  powdering.  This  class  of  foods  includes  beef 
meal,  somatose  and  other  such  products  (see  page  20).  Of  the  concen- 
trated vegetable  proteins  may  be  mentioned  aleurona  and  legimiin. 

Dried  Vegetables — Dried  vegetables  keep  much  better  than  dried 
meats.  Coffee,  tea  and  cocoa  are  good  examples  of  dried  vegetable  sub- 
stances. They  may  be  extracted  and  then  concentrated  by  evaporation. 
Potatoes  are  concentrated  by  a  drying  process  to  less  than  one-third  of 
their  weight,  and  in  this  shape  may  be  preserved  for  future  use;  so  may 
carrots,  cauliflower  and  the  like.  They  are  prepared  by  being  exposed  to 
the  direct  rays  of  the  sun,  and  are  serviceable  only  for  relieving  monotony 
of  the  diet  when  fresh  vegetables  cannot  be  obtained.  (See  Volume  IT, 
Chapter  IT.) 

Desiccated  Vegetables. — Desiccated  vegetables  have  been  used  to  some 
extent  in  the  United  States  Navy,  but  it  has  been  found  that  they  possess 
fewer  antiscorbutic  properties  than  fresh  vegetables.  Bread  is  frequently 
dried  and  eaten  in  the  form  of  'Tiard-tack"  when  it  is  impossible,  as  during 
long  voyages,  to  obtain  fresh  bread.  TTard-tack  may  be  preserved  for  a 
long  time,  but  it  becomes  tasteless  and  is  useful  only  in  emergencies. 


FOOD    COA^CENTKATION  71 

Captain  Woodruff (^)j  of  the  Medical  Corps  of  the  United  States  Anny, 
writes  on  this  subject  as  follows : 

The  Germans  have  been  the  first  to  take  advantage  of  drying  and  compressing 
processes  in  the  manufacture  of  a  dried,  compressed  bread.  Tlie  great  difficulty 
in  the  use  of  bread  for  field  use  consists  in  the  inability  to  supply  it  so  that  it  will 
keep  a  long  time  and  be  digestible.  Hard-tack  is  ruinous  to  many  soldiers,  as  al- 
ready pointed  out.  If  baker's  -bread  is  compressed,  it  sinks  into  a  heavy  dough. 
Only  strong  stomachs  can  digest  it,  and  it  is  far  worse  than  the  soggy,  hot  break- 
fast bread  with  which  we  cultivate  dyspepsia.  If  the  bread  is  merely  dried,  it  is 
too  bulky  for  transportation.  By  a  new  process,  which  probably  consists  in  dry- 
ing the  bread  and  at  the  same  time  compressing  it  by  improved  machinery,  the 
Germans  have  secured  a  variety  of  field  bread  which  is  spoken  of  in  very  high 
terms.  Small  bits  of  it  thrown  into  soup  swell  up  like  a  dried  sponge  when  thrown 
into  hot  water.  The  soldiers  are  said  to  be  very  fond  of  it,  and  as  far  as  known 
it  is  entirely  successful. 

Desiccated  Milk — This  is  now  prepared  by  drying  in  vacuo  fresh 
cow's  milk.  It  is  offered  as  a  sterilized  food  for  the  artificial  feeding  of 
infants  (see  Volume  II,  Chapter  II). 

Desiccated  Eggs. — These  are  also  offered  as  a  substitute  for  fresh  eggs, 
but  the  product  is  very  inferior  to  fresh-laid  hens'  eggs.  The  albumin  of 
egg  dries  in  thin  scales  which  may  be  indefinitely  preserved,  but  the  yolk 
is  not  so  well  taken  care  of. 

Dried  Meat. — The  preservation  of  meat  and  fish  by  drying  is  probably 
the  oldest  of  the  primitive  methods  of  preserving  meat.  This  method  of 
drying  meat  is  practiced  extensively  among  savage  tribes  in  most  parts 
of  the  world,  but  especially  where  purity  of  atmosphere  combined  with 
intense  heat  and  dryness  of  climate  will  cause  the  water  to  evaporate  from 
the  meat  so  rapidly  that  germs  do  not  have  time  to  decompose  it.  Meat 
to  be  preserved  in  this  manner  must  necessarily  be  lean,  as  the  fat  does 
not  part  with  its  water  with  suffici'Mit  rapidity.  Dried  meat  loses  consid- 
erably in  weight,  becomes  hard  and  tough,  and  in  uiauy  instances  taste- 
less. Such  meat  is  usually  very  indigestible,  and  reiniiros  prolonged  cook- 
ing and  liberal  seasoning.  Dried  meats  may  be  predigested,  evaporated 
and  made  into  a  paste  for  broths  or  used  to  reenforce  various  food  prepa- 
rations for  invalids.    Meat  extracts  have  been  described  in  Vol.  I,  p.  287. 

Concentration,  according  to  Colonel  Woodruff (8),  means  only  the 
extraction  of  the  indigestible  portions  of  the  food  and  part  of  the  water. 
Thus  the  garrison  ration  gives  to  each  man  about  five  pound?  of  food,  of 
which  only  four  pounds  are  eaten,  and  it  is  impossible  to  condense  this 
amount  so  that  it  will  be  much  less  than  three  pounds.  All  foods  that  are 
compressed  and  dried  still  contain  from  f)  to  12  per  cent  of  water.     The 


72 


SCIENTIFIC    COOKERY 


German  soldier's  war  ration  is  equivalent  to  about  two  pounds  of  water- 
free  food  in  the  above  sense.  This  is  not  enough  for  American  soldiers 
during  hard  work,  yet  it  is  possible  in  an  emergency  to  give  the  soldier 
fairly  good  nourishment  with  these  improved  foods,  and  not  allow  the 
weight  to  be  over  two  pounds,  as  seen  in  the  following  table,  in  which  the 
analyses  are  only  approximate: 

COMPOSITION  OF  EMERGENCY  RATION  OF  THE  GERMAN  SOLDIER 


Grams 

Articles 

Protein 

Fats 

Carbo- 
hydrates 

Salts 

Calories 

Weights 

3   cubes   dried   compressed 
bread,  ^  pound  each. . . 

3  packages  compressed  soup, 
6  ounces  each 

35 
100 

4 
150 

250 
200 

2 

28 

1,233 
2,625 

Mlb. 
VA  « 

3  tablets  compressed  tea  or 
coffee  ready  for  use,  pos- 
sibly a  tablet  of  dried 
fruit 

u 

Total 

135 

154 

450 

30 

3,858 

*2  lbs. 

*  Gross  Weight. 

The  composition  of  the  bread  is  assumed  to  be  the  same  as  ordinary 
flour,  and  the  tablets  of  soup  can  be  manufactured  of  the  given  composi- 
tion. As  usually  made,  the  tablets  do  not  contain  so  much  fat,  which  is 
here  purposely  increased  in  order  to  give  the  necessary  energy.  Even  with 
this  increase  they  would  not  contain  as  much  as  the  first  specimens  of 
Erbswurst. 

For  purposes  of  detached  service  the  United  States  soldier  has  been 
Kupplied  as  follows: 

COMPOSITION  OF  COMPONENTS  OF  THE  RATION  OF  THE  UNITED 

STATES    SOLDIER 


Grams 

Components  of  Ration 

Protein 

Fats 

Carbo- 
hydrates 

Salts 

Calories 

Weights 

1  pound  hard-tack 

5^  pound  bacon 

50 
27 

5 
236 

340 

2H 
8^ 
19 

1,644 
2,310 

1      lb. 

Coffee,  sugar  and  salt 

H    " 

Total 

77 

241 

340 

30 

3,054 

2  lbs 

BIBLIOGRAPHY  73 

EEFERENCES 

1.  Sykes.     Principles  and  Practice  of  Brewing. 

2.  Gkindley.     Studies  of  the  Effect  of  Different  Methods  of  Cooking 

upon  the  Thoroughness  and  Ease  of  Digestion  of  Meat,  U.  S. 
Dept.  Agric,  Exper.  Sta.,  Bull.  193,  1907,  Washington,  D.  C. 

3.  BuLLEX,  F.  T.     The  Cruise  of  the  Cachalot,  p.  273,  pub.  by  Smith, 

Elder  and  Co.,  London. 

4.  Spkague  and  Grtndley.     A  Precise  Method  of  Roasting,  Bull.  No. 

4-19,  Univ.  of  Illinois,  May  15,  1907. 

5.  Williams.     Chemistry  of  Cookery,  p.  158. 

6.  Williams,  M.     Chemistry  of  Cookery,  J.  Chem.  Soc.,  p.  158. 

7.  Kraus.     Ztschr.  f.  diatet.  u.  physik.  Therap. 

8.  Woodruff.     J.  Am.  Cavalry  Assn. 


BIBLIOGRAPHY 

Grindley,  H.  B.   Meat  Losses  in  Cooking,  U.  S.  Dept.  Agric,  Bull.  141. 
Chief  Loss  During  Cooking  of  Meats,  U.  S.  Dept.  Agric, 

Far.  Bull.  No.  162. 
Snyder.     Studies  in  Bread  Making,  U.  S.  Dept.  Agric,  Bull.  67,  101 

and  126. 


CHAPTEK   IV 


THE    HYGIENE    OF   EATING 

The  Creator  in  compelling  man  to  eat  that  he  may  live,  invites  him  through 
appetite  and  rewards  him  with  pleasure. 

The  Hole  of  the  Senses  in  the  Pleasure  of  Eating. 

Effect  of  the  Manner  of  Eating  on  Digestion:  Euphagia;  Food  and  Emo- 
tion;  Bradyphagia :   Tachypliagia;   Evils  of  Overinastication. 

The  Drinking  of  Water  with  Meals. 

Personal  Idiosyncrasies. 

Order  and  Frequency  of  Meals:  For  Healthy  Individuals  and  in  Diseased 
Conditions;  For  Persons  Engaged  in  Heavy  ^lanual  Labor,  Skilled 
Labor,  Professional  Vocations,  Commercial  Life;  For  Those  Who 
Lead  Lives  of  Leisure;  For  Night  Workers. 

Kegularity  of  Meals. 

Sleep  and  Digestion. 

Occupation  and  Digestion. 

Variety  in  Diet. 

Kelation  of  Medication  to  Meals. 


THE  ROLE  OF  THE  SENSES  IN  THE  PLEASURE  OF  EATING 

The  above  quotation  is  a  sublime  aphorism  of  the  great  deipnosophist 
who  regaled  his  readers  with  a  vast  abundance  of  gastronomic  lore,  em- 
phasizing the  correlative  influences  of  the  five  senses  on  the  pleasure  of 
eating. 

"True  it  is  that  nearly  all  animated  beings  are  endowed  with  special 
senses,  but  man,  alone,  is  granted  the  faculty  of  cultivating  them  to  a 
very  high  degree  for  bodily  nourishment  and  mental  enrichment  as  well 
as  for  other  purposes.  Forced  by  hunger  to  eat  for  his  sustenance,  he 
labored  diligently  in  seeking  the  necessary  aliments  which,  originally,  he 
had  found  through  the  aid  of  certain  lower  creatures  whose  movements 
he  had  cunningly  espied.  The  first  sense  he  naturally  exercised  was  that 
of  sight;  the  second,  touch,  when  with  his  hand  he  seized  an  edible  sub- 
stance and  carried  it  toward  a  third  sense  organ  which  gave  him  its  odor, 
then  greedily  thrust  it  into  his  mouth  to  awaken  the  giisfafive  sense;  the 
clattering  of  his  teeth  pleasantly  rousing  the  auditive  sense.     Thus  were 

75 


76  THE    HYGIEXE    OF    EATING 

the  five  senses  gratified  whilst  hunger  was  satisfied;  appetite,  that  is  to 
say,  the  desire  to  eat  tasty  food,  became  agreeable,  being  the  outcome  of 
that  primitive  experience." 

The  high  cultivation  of  the  senses  in  man  gives  him  supremacy  over 
other  animated  beings  in  his  struggle  for  existence.  In  the  animal  king- 
dom, as  well  as  among  uncivilized  peoples,  the  securing  of  food  for  suste- 
nance forms  the  principal  occupation  during  life.  The  necessity  of  ob- 
taining food  has  remained  the  same  with  civilized  man,  but  the  manner 
of  partaking  it  has  been  changed,  partially  to  his  disadvantage.  ISTew  in- 
terests have  arisen  and  the  act  of  eating  has  been  in  a  measure  relegated 
to  the  background.  In  this  age  of  frenzied  finance,  in  busy  metropol- 
itan centers,  persons  scarcely  take  time  to  eat  \  they  swallow  hastily  any 
kind  of  food,  without  special  selection,  which  is  often  very  poorly  prepared. 
The  natural  consequence  is  that  under  these  conditions  diseases  of  the 
alimentary  system  are  more  frequent  than  in  the  early  days. 

Individuals  whose  sense  organs  are  abnormal,  whose  perceptions  are 
naturally  dull  or  accidentally  obtunded,  or  whose  mental  faculties  are  un- 
tutored, have  little  if  any  real  pleasure  in  eating.  "Hunger  and  thirst  they 
feel,  and  beast  like,  brutally  appease,  but  they  have  no  true  appreciation 
of,  or  appetite  for,  dainty  food  or  for  its  use  in  moderation ;  whilst  those 
of  cultured  mind  and  sound  body,  in  the  enjoyment  of  delicacies,  bring 
into  play  all  of  their  senses  to  enhance  the  pleasure  of  eating."  This  is 
aptly  summed  up  in  the  aphorism: 

The  beasts  feed,  man  eats,  but  Only  men  of  genius  know  how  to  eat. 

"The  gustative  sense,  one  of  the  most  precious  endowments  of  the  Cre- 
ator to  the  creature,  is  granted  to  nearly  all  animated  beings,  but  man 
alone  is  able  to  cultivate  this  sense  to  its  highest  possibilities.  Probably 
prehistoric  man,  from  watching  an  animal  in  the  act  of  ingesting  food, 
tried  it,  but  found  it  malodorous,  nauseous,  unsavory,  so  he  rejected  it. 
Finding  another  kind  of  food  in  which  he  perceived  a  fragrance  and  sapid- 
ity, after  bruising  it  in  his  mouth,  he  swallowed  because  of  the  pleasing 
buccal  sensation  it  produced.  Gustation,  therefore,  may  be  defined  as  the 
perception  and  distinction  of  savory  and  unsavory  qualities  of  ingesta. 

"Taste,  like  many  other  words  pertaining  to  the  alimentation  of  man's 
body,  is  largely  used  figuratively,  as  in  the  expressions  "good  or  bad  taste" 
or  simply  taste  or  its  want,  "de  (justihus  non  est  disputandum"  being  ap- 
plied to  both  the  original  term  and  its  figurative  use.  For  instance,  an 
aliment  may  be  gustful  to  one  individual  and  disgustful  to  another. 

"The  seat  of  gustation  is  at  the  base  and  sides  of  the  tongue,  the  base 


THE    HOLE    OE    THE    SE.XSEJS  77 

being  the  region  of  the  circumvallate  papillae,  and  the  side  the  region  of 
the  fungiform  papillae.  The  exquisitely  delicate  filiform  papillae,  dis- 
seminated upon  nearly  the  whole  upper  surface  of  the  tongue,  are  purely 
tactile,  while  the  gustatory  papillie  are  furnished  with  taste  bulbs.  Be- 
sides ramilications  of  twigs  from  the  giossojjharyngeal  nerve  and  lingual 
branch  of  the  trigeminal,  the  circumvallate  papillae  contain  minute  gusta- 
tivc  bulbs  (discovered  by  Schwalbe  and  Loven  in  18G7).  These  gustative 
bulbs  exist  also  in  the  fungiform  papillae.  Thus  the  chain  of  specializing 
bodies  in  the  sense  end-organs  is  complete,  from  the  retinal  rods  and  cones, 
the  tactile  corpuscles  and  pacinian  bodies,  the  olfactory  cells  in  the  upper 
yellow  region  of  the  nasal  mucous  membrane,  to  the  organs  of  Corti  in  the 
internal  ear." 

Tasty  aliments  are  often  designated  as  "palatable,"  although  the  pal- 
ate is  passive  in  gustation,  its  office  being  purely  mechanical  and  serving 
as  a  hard,  fixed  surface  against  which  the  tongue  bruises  the  food  to  ex- 
press and  diffuse  sapid  particles  for  quick  solution  by  the  saliva,  without 
which  there  would  be  no  gustation  of  solids.  The  other  parts  of  the  buccal 
cavity  possess  no  more  than  tactile  properties. 

It  has  been  stated  by  competent  physiologists  that  there  are  but  two 
veritable  savors  recognizable  through  the  gustative  bulbs,  namely:  the 
sweet  and  the  bitter ;  while  others  equally  competent  have  identified  three 
additional  savors :  the  saline,  the  alkaline  and  the  acid.  However,  sweet, 
bitter,  salt  and  sour  are  almost  universally  accepted.  But  all  reject  the 
idea  of  acrid  savors,  which  really  result  from  mechanical  action  of  acid 
substances  upon  the  tactile  papillae,  and  ignore  the  so-called  aromatic  savor 
M-hich  belongs  to  olfaction,  Nevertheless  the  concurrence  of  the  tactile  and 
olfactory  senses  is  essential  to  perfect  gustation  and  to  the  full  enjoyment 
of  delicious  aliments. 

Taste,  then,  with  its  closely  associated  olfactory  and  tactile  senses,  is 
regarded,  gastronomically,  as  the  special  and  general  pleasure  evoked  by 
the  perception  and  specialization  of  the  crispness,  of  the  succulence,  sapid- 
ity, and  perfume  of  aliments;  and  figuratively  as  a  judgment  of  the  beau- 
tiful, the  sublime  and  the  picturesque. 

The  proper  hygiene  of  eating  is  too  often  unjustly  decried  as  sybarit- 
ism by  the  thoughtless ;  but  students  of  rational  deipnosophism  admit  that 
the  wise  cultivation  of  the  divine  gift  of  the  five  senses  is  not  only  essen- 
tial to  the  real  enjoyment  of  edibles  but  is  a  blessing  without  which  man 
would  be  but  little  above  the  beast.  The  pleasure  of  eating  should  be  the 
reward  for  the  lalx)r  of  gathering,  preparing,  serving  and  coiisnniing  tlie 
food. 


78  THE    HYGIE:NE    OF   EATING 

In  observing  the  proper  hygiene  of  eating,  it  behooves  one  to  insist 
that  wholesome  aliments  be  rendered  appetizing  and  pleasing  to  the 
senses ;  only  ascetics  denounce  a  gourmet  by  saying,  "It  is  bestial  to  make 
eating  an  absorbing  object  of  thought.  A  man  should  eat  to  satisfy  hun- 
ger ;  but  if  he  allows  his  mind  to  run  on  his  food,  he  will  become  a  glut- 
ton and  beast  at  the  cost  of  his  soul."  Such  a  charge,  while  not  really 
applicable  to  the  gourmet,  could  only  have  been  made  by  one  known  to 
live  on  the  commonest  of  foods  and  one  whose  gustative  sensibility  has 
long  since  been  obtunded  and  who  does  not  care  for  good  fellowship.  It 
is  only  too  well  known  that  the  veritable  gourmet  always  has  a  good  cook, 
and  is  never  gluttonish.  He  is  a  daintier  eater,  only  giving  sufficient 
thought  to  his  daily  food  to  insure  its  excellence  of  quality,  and  regarding 
a  moderate  and  reasonable  gratification  of  appetite  and  gustative  sense 
as  pertaining  to  human  intellect,  and  the  mere  satisfaction  of  hunger  as  of 
beastly  instinct.  The  gastrolater  is  one  who  makes  eating  "an  absorbing 
object  of  thought"  and  who  in  brutish  style  devours  large  quantities  of 
food,  regardless  of  quality.  He  does  not  become  gluttonous,  for  he  was 
bom  a  glutton. 

"Good  alimentary  hygiene,  like  good  German  grammar" (1),  involves 
a  clear  knowledge,  first  of  rules,  then  of  exceptions,  and  finally  of  excep- 
tions to  exceptions.  An  ideally  healthful,  well-regulated  life  involves 
painstaking  regularity  in  eating,  drinking,  sleeping,  exercise  and  modera- 
tion, as  well  as  avoidance  of  risks.  But  it  is  occasionally  necessary  to 
resort  to  irregular  and  excessive  demands  even  to  the  point  of  danger,  in 
order  to  develop  moral,  mental,  muscular  or  digestive  strength,  and  the 
"exception  to  the  exception"  is  that  one  must  be  careful  not  to  make  irreg- 
ularity itself  a  routine,  nor  to  make  the  physical  test  a  strain  nearing  the 
danger  point,  nor  to  disregard  carelessly  the  experience  of  other  observers, 
or  even  his  own,  in  running  risks. 

Eating  or  partaking  of  food  is  the  only  means  by  which  life  is  sus- 
tained. Without  it  the  human  organism  cannot  thrive,  cannot  gain  in 
weight,  cannot  grow.  Total  abstinence  from  food  causes  the  body  to  lose 
steadily  in  weight,  and  results  in  death. 

EFFECT  OP  THE  MANNER  OF  EATING  ON  DIGESTION 

Euphagla — Euphagia,  or  the  art  of  eating  properly,  like  all  natural 
processes,  if  performed  under  the  proper  hygienic  conditions,  afi^ords  the 
body  the  greatest  pleasure  and  satisfnction.  In  order  to  receive  the  greatest 
pleasure  from  the  partaking  of  food,  the  organism  must  be  prepared  by 


EFFECT    OF    THE    MARKER   OF    EATIKG  79 

previous  work,  followed  by  a  short  period  of  rest.  lu  Holy  Writ,  we  find  a 
quotation :  ''In  the  sweat  of  thy  brow  shalt  thou  eat  bread,"  which  empha- 
sizes the  importance  of  work  preceding  the  partaking  of  food.  A  German 
proverb,  "Arbeit  macht  das  J.eben  siiss"  (Work  sweetens  life),  emphasizes 
not  oidy  the  pleasure  derived  from  eating,  but  from  all  other  functions 
of  life.  Even  if  it  is  admitted  that  work  is  essential  to  the  pleasure 
and  satisfaction  of  eating,  still  it  must  not  be  in  excess  or  lead  to  exhaus- 
tion, as  in  this  condition  the  appetite  usually  lags  and  digestion  becomes 
sluggish. 

Food  and  Emotions — Meals  should  be  served  only  after  a  short  period 
of  rest,  allowing  plenty  of  time  for  the  repast.  During  mealtime  the  emo- 
tions should  not  be  disturbed,  either  by  anger  or  grief.  The  whole  and 
undivided  attention  should  be  given  to  the  meal (2).  Pleasant  company, 
light  conversation,  jokes  and  stories  add  to  the  enjoyment  of  food.  It  is 
well  understood  that  the  brain  exerts  a  powerful  influence  on  the  process 
of  digestion.  Great  grief  or  anger  deters  appetite  and  may  seriously 
hinder  the  process  of  digestion. 

Pavlov (8)  has  established,  beyond  question,  the  great  physiological  im- 
portance of  the  mental  state  on  digestion,  having  successfully  demonstrated 
that  the  sight  of  delicacies  exerts  a  stimulating  influence  upon  the  secre- 
tion of  gastric  juice  even  before  the  viands  are  eaten.  Food  to  be  enjoyed 
must  not  only  be  properly  prepared  and  palatable  but  must  be  served  in 
an  attractive  manner.  There  can  be  no  question  that  a  well-laid  table, 
snow-white  linen,  polished  silver,  crystalline  drinking  vessels,  beautiful 
floral  decorations,  and  the  good  taste  displayed  in  all  the  appurtenances- 
of  a  well-ordered  dinner,  delight  the  visual  impression  with  each  course 
throughout  the  repast  and  heighten  the  pleasure  of  eating. 

Physiologists  and  dietitians  guided  by  the  work  done  by  Pavlov  and 
Cannon  on  digestion  and  nutrition  are  realizing  more  and  more  the  po- 
tency of  the  psychic  factors  concerned  in  the  process  of  digestion,  and  he 
who  comprehends  only  the  chemical  and  mechanical  aspects  of  these  all- 
important  questions  sees  as  "through  a  glass  darkly"  and  needs  to  sweep 
the  cobwebs  from  his  brain. 

When  a  hungry  diner  approaches  an  attractively  laid  table  with  an 
appetizing  meal  thereon,  both  his  eyes  and  olfactories  set  in  motion  the 
preliminaries  to  the  digestion  of  the  food  in  sight.  As  the  food  is  received 
by  the  waiting  gustatory  tract,  it  is  comminuted  and  insalivated  just 
sufiiciertly  to  promote  easy  deglutition  and  allow  the  savory  taste  and 
aroma  arising  therefrom  to  be  thoroughly  appreciated.  During  mastica- 
tion numerous  messages  are  dispatched  to  the  stomach,  the  pancreas,  the 


80  THE    HYGIENE    OF    EATING 

duodenum  aud  the  other  organs  concerned  in  the  process  of  digestion,  in- 
forming them  in  code  message  readily  understood  how  much  and  what 
kind  of  aliment  is  being  dispatched  to  them  to  digest.  When  such  mes- 
sages are  of  cheerful  import,  these  organs  at  once  take  to  their  tasks  with 
alacrity,  performing  them  with  such  ease  and  expedition  that  the  diner 
need  not  know  that  he  even  possesses  a  stomach. 

But,  on  the  other  hand,  should  the  same  meal  be  approached  with 
severe  gastronomic  contemplation  and  with  arduous  and  lengthy  mastica- 
tion, the  message  may  be  ''flashed"  to  the  waiting  accessory  organs,  "Your 
master  has  lost  conlidence  in  you ;  the  mouth  and  teeth  will  take  over 
most  of  your  former  duties,  and  hereafter  you  will  be  under  constant  men- 
tal surveillance."  It  can  readily  be  perceived  that  under  such  a  mental 
state  digestion  is  performed  in  a  tedious,  faulty,  complaining  and  unsat- 
isfactory manner,  and  we  may  well  say  that  "the  last  state  of  that  man  is 
worse  than  the  first." 

The  effect  of  the  emotions  on  digestion  has,  until  recently,  received 
scant  attention  at  the  hands  of  physiologists;  in  consequence,  our  knowl- 
edge of  the  emotional  states  on  the  process  of  digestion  has  been  meager. 
Cannon (2)  has  placed  before  the  profession  the  result  of  his  four  years' 
study  of  this  subject  in  the  Harvard  Physiological  Laboratories,  and  his 
published  researches  have  thrown  light  on  a  hitherto  dark  subject.  We 
are  well  acquainted  with  many  surface  manifestations  under  strong  emo- 
tion. The  contraction  of  the  blood  vessels  with  resulting  pallor,  the  pour- 
ing out  of  "cold  sweat,"  the  stopping  of  the  flow  of  saliva  so  that  the 
"tongue  cleaves  to  the  roof  of  the  mouth,"  the  dilation  of  the  pupils,  the 
"rising"  of  the  hairs,  the  rapid  beating  of  the  heart,  the  hurried  respira- 
tion and  the  trembling  and  twitching  of  the  muscles,  especially  those  about 
the  lips;  these  bodily  changes  are  well-recognized  accompaniments  of  pain 
and  great  emotional  distiirbances,  such  as  fear,  horror  and  deep  disgust. 
Tliese  manifestations  of  the  emotions  commonly  noted  are  mainly  super- 
ficial and  readily  observable.  The  internal  organs  of  the  body  do  not  re- 
veal so  obviously  the  disturbances  of  action  which  attend  states  of  intense 
feeling.  The  organs  most  affected  to  an  important  degree  by  the  feelings 
are  those  concerned  with  digestion. 

Cannon,  in  his  recent  investigations,  has  shown  that  not  only  are  "the 
first  stages  of  the  digestive  process  normally  started  by  the  pleasurable 
taste  and  smell  and  sight  of  food,  but  also  that  pain  and  great  emotional 
excitement  can  seriously  interfere  with  the  starting  of  the  process  or  its 
continuation  after  it  has  been  started."  The  conditions  favorable  to 
proper  digestion  are  wholly  abolished  when  unpleasant  feelings  such  as 


EFFECT    OF    THE    MANNEK    OF    EATING  81 

vexatioiij  shame,  worry  and  anxiety,  or  great  emotions  such  as  anger  and 
fear,  are  allowed  to  prevail.  It  has  long  been  known  that  the  salivary 
secretion  is  seriously  affected  by  fear  or  "stage  fright" ;  and  the  "ordeal  of 
rice,"  employed  in  India  to  detect  criminals,  was  a  practical  utilization 
of  the  knowledge  that  excitement  is  capable  of  inhibiting  the  flow  of 
saliva  (»'}). 

Other  digestive  glands  than  the  salivary  and  gastric  are  influenced  in 
emotional  excitement.  Oechsler(4)  reports  a  study  of  psychic  disturb- 
ances showing  that  emotional  excitement  suppresses  secretion  of  the  gas- 
tric juice,  the  secretion  of  the  pancreatic  juice  and  definite  hindrance  of 
the  flow  of  bile.  The  secretion  from  the  various  organs  concerned  in  the 
process  of  digestion  and  the  chemical  changes  produced  by  them  are  of 
little  value  unless  the  chyme  is  normally  propelled  along  the  alimentary 
canal,  and  just  as  the  secretory  activities  of  the  stomach  are  unfavorably 
influenced  by  the  strong  emotions,  so  also  are  the  ipovements  of  almost 
the  entire  alimentary  canal  practically  arrested  under  great  excitement. 
Cannon,  by  means  of  the  roentgen  rays,  the  most  fruitful  of  all  the  tech- 
nics applied  in  this  field  of  study,  was  able  to  observe  the  movements  of 
the  alimentary  canal  in  animals,  and  in  some  of  his  experiments  the  waves 
of  contraction  were  perfectly  evident,  while  in  others  there  was  not  the 
slightest  sign  of  activity.  The  peristaltic  waves  in  the  stomach,  and  the 
peristalsis  in  the  small  intestine,  and  reversed  peristalsis  in  the  large  in- 
testine all  ceased  when  the  observed  animal  was  in  a  state  of  emotional 
excitement. 

Other  sensory  stimuli  bring  about  similar  inhibitions  of  gastric  peri- 
stalsis which  can  actually  be  observed  in  certain  animals  (rabbits)  without 
any  operative  interference  whatever,  by  mere  inspection  of  the  epigastrium 
as  des(;ribed  by  Auer(5).  The  stoppage  of  intestinal  peristalsis,  after 
similar  inhibitory  influences  are  brought  to  bear,  has  been  described  for 
the  Inmian  subject  by  various  observers  who  used  the  roentgen  ray  method. 
If  further  evidence  were  needed  to  give  emphasis  to  the  profound  de- 
pendence of  the  activity  of  the  stomach,  as  regards  both  its  secretory  and 
motor  functions,  on  the  "condition"  of  the  nervous  system,  additional 
proofs  could  easily  be  adduced.  Quite  recently  a  large  number  of  facts 
have  been  gathered  in  the  pharmacologic  institute  at  Utrecht  directly  ap- 
plicable to  the  question  at  issue.  They  involve  a  careful  record  of  the  rate 
of  discharge  of  bismuth  meals  from  the  stomachs  of  laboratory  animals  in 
various  stages  of  psychic  calmness  or  perturbation,  but  under  otherwise 
comparnblo  conditions.  Without  attempting  to  group  the  emotional  states 
into  well-defined  categories,  we  may  describe  the  subjects  as  ranging  from 


82  THE    HYG1E:NE    OF   EATING 

individuals  tame,  unperturbed,  readily  amenable  to  handling  and  freely 
submissive  to  observation,  on  the  one  hand,  to  wild,  frightened  or  re- 
fractory subjects  on  the  other.  Corresponding  with  these  emotional  states 
the  discharge  of  the  meal  from  the  stomach  ranged  in  time  from  one  and 
a  half  hours  in  the  former  group  to  three  or  even  more  hours  in  the  case 
of  the  most  unamenable  subjects.  Such  figures  are  more  expressive  than 
a  dozen  sermons  on  the  importance  of  a  proper  state  of  the  nervous  sys- 
tem in  the  normal  performance  of  some  of  the  functions  of  alimentation. 

The  conclusion  is  that  the  activity  of  the  stomach  in  man  is  affected 
similarly  to  that  in  the  lower  animals ;  so,  likewise,  the  gastric  and  intes- 
tinal peristaltic  waves  are  stopped  in  man  as  they  are  stopped  in  lower 
animals  by  worry,  anxiety  and  other  conditions  of  mental  discord.  Thus 
we  see  that  the  emotional  life  of  an  individual  exerts  a  marked  influence 
upon  all  gastro-intestinal  activity.  Fully  50  per  cent  of  the  action  of  gas- 
tric secretions  is  psychic  and  at  least  partially  dependent  upon  hedonistic 
approach.  The  intrinsic  relationship  between  man's  emotional  state  and 
the  operation  of  his  primitive  instincts  is  axiomatic.  In  the  field  of  nutri- 
tion, the  proper  selection  of  nutritional  elements  is  a  matter  of  protoplas- 
mic activity  of  the  original  cell. 

An  individual  in  normal  health,  taking  a  reasonable  aniount  of  exer- 
cise, does  best  to  follow  his  natural  appetites  with  regard  to  quantity  and 
quality  of  food,  though  an  intelligent  appreciation  of  physiologic  demands 
and  the  nature  of  the  aliment  is  always  of  considerable  value.  Sanitarium 
life  is  particularly  demoralizing  to  persons  who  think  too  much  of  their 
digestive  physiology.  Society  matrons  and  debutantes  who  have  nothing 
to  occupy  their  minds  except  dress  and  eating,  become  morbid  from  think- 
ing too  much  of  what  they  shall  wear  and  particularly  of  what  they  shall 
eat.  Some  physicians,  too,  become  health  cranks  from  constant  applica- 
tion of  their  professional  ideas  to  themselves  and  their  families.  Health 
cranks  of  all  kinds  are  usually  the  product  of  imperfect,  unqualified  infor- 
mation carried  to  an  extreme  in  one  direction. 

Bradyphagia. — One  of  the  most  prominent  advocates  of  this  class,  in 
recent  times,  is  Mr.  Horace  Fletcher(6),  an  apostle  of  deliberate  mastica- . 
tion — hradyphagia.     He  has  so  largely  devoted  his  energies  to  this  topic 
that  slow  eating  has  come  to  be  called  "fletcherism," 

Mr.  Fletcher,  when  about  to  pass  the  middle  milestone  in  life's  jour- 
ney, found  himself  obese,  dyspeptic  and  discouraged ;  at  this  point  he  dis- 
covered that  by  slow  and  deliberate  mastication  his  health  seemed  to  im- 
prove. He  then  began  to  elaborate  this  supposedly  new  principle,  claiming 
that  he  literally  chewed  himself  back  into  normal  health  and  averring  that 


EFFECT    OF    THE    MANNEE    OF    EATING  83 

by  extreme  mastication  and  iusalivation  of  food,  hunger  was  satisfied  with 
a  much  smaller  amount  than  ordinarily  craved,  while  at  the  same  time  his 
physical  and  mental  well-being  were  enhanced.  Mr.  Gladstone,  an  Eng- 
lishman, anticipated  Mr.  Fletcher  as  the  first  advocate  of  prolonged  masti- 
cation and  attributed  nmch  of  his  success  in  public  life  to  the  fact  that  he 
had  always  made  it  a  rule  in  eating  to  give  every  tooth  a  chance  at  the 
chewing. 

Bradyphagia  means  eating  too  slowly — a  condition  in  which  mastica- 
tion is  performed  at  an  abnormally  slow  rate,  often  leading  to  injury  of 
the  body  economy.  Mastication  normally  is  an  entirely  voluntary  act, 
while  the  performance  of  swallowing  is  a  complicated  reflex  movement 
which  is  usually  initiated  voluntarily,  but  is,  for  the  most  part,  completed 
involuntarily.  Under  normal  conditions  the  presence  on  the  tongue  of 
masticated  food  seems  essential  to  the  completion  of  this  act,  and  we 
might  add  that  a  pleasant  taste  coupled  with  a  favorable  attitude  still 
further  facilitates  the  act  of  swallowing  and  the  passage  of  food  through 
the  esophagiis  into  the  stomach. 

Prolonged  mastication  may  be,  and  often  is,  overdone  by  many  people 
to  their  detriment.  In  many  cases  every  morsel  is  masticated  and  remas- 
ticated,  carrying  out  the  Gladstone  dictum  of  32  bites  for  each  morsel, 
and  before  being  swallowed  is  again  chewed  and  everything  carefully 
tested  with  the  tongue  to  see  that  it  is  thoroughly  comminuted.  The 
fletcherite  has  an  abnormal  fear  and  suspicion  that  something  dreadful 
will  happen  unless  he  masticates  his  food  as  laid  down  by  Fletcher  in  his 
"A  B  C  of  initrition,"  which  as  a  theory  has  grown,  budded  and  blossomed 
so  popularly  that  eating  has  become  a  difiicult  task.  The  enjoyment  and 
pleasure  of  eating  are  transformed  into  a  doleful  process  and  a  much 
smaller  quantity  of  food  is  ingested.  It  not  infrequently  happens  that 
the  bolus  of  food  remains  in  the  pharynx  or  esophagiis  and  refuses  to 
budge.  It  is  not  an  organic  affection  that  causes  this  dysphagia,  but 
merely  excitement  and  fear  of  eating.  In  such  individuals,  of  course,  in 
time  a  chronic  inanition  develops  owing  to  bradyphagia  and  the  added 
temporary  dysphagia,  in  consequence  of  which  the  patient  gradually  be- 
comes weaker  and  sometimes  even  dies. 

We  admit  the  necessity  for  the  moderate  chewing  of  meats  and  urge 
the  most  thorough  mastication  of  carbohydrate  foods.  In  diseased  condi- 
tions with  impaired  chemical  functions  of  the  stomach,  or  where  a  neo- 
plasm constricts  the  pylorus,  fine  mastication  and  thorough  insalivation 
of  foods  are  not  only  highly  beneficial,  but  necessary.  Fletcherism  is  also 
permissible  in  those  easy-going,  lackadaisical  individuals  whose  tastes  arc 


84  THE    HYGIENE    OF    EATIN^li 

gently  epicurean  aud  who  possess  the  desires  of  a  Luciilhis  minus  the 
means.  Let  those  benighted  harmless  souls  chew  and  champ  to  their 
heart's  content,  for  they,  poor  beings,  need  some  fad,  and  this  one  can 
harm  no  one  unless  it  be  themselves.  But  to  busy  men  who  are  shoulder- 
ing the  cares  of  government,  commerce  and  science,  and  whose  strenuous 
impetuosity  moves  them  to  act  quickly,  whose  every  act  is  intense  and 
every  movement  a  flash — to  such  individuals,  fletcherism  is  a  thorn  in  the 
flesh. 

Einhorn(7)  reports  a  case  of  bradyphagia — a  lawyer  32  years  of  age, 
who  consulted  him  for  digestive  disturbances  and  gave  a  history  of  having 
lost  considerable  flesh  and  of  being  unable  for  the  previous  three  years  to 
attend  to  business.  He  complained  of  an  inability  to  swallow  food  and  of 
intense  pains  in  the  upper  abdominal  region  particularly  after  meals. 
This  patient  had  lost  more  than  40  pounds,  of  which  only  a  small  portion 
was  lost  during  the  previous  six  months.  He  was  a  strict  follower  of  the 
ideas  of  Fletcher ;  he  ate  very  slowly,  taking  as  long  as  half  an  hour  to 
consume  a  glass  of  milk.  He  was  emaciated,  and  an  examination  of  the 
thoracic  organs  gave  negative  results.  The  lower  border  of  the  stomach 
reaching  two  inches  below  the  navel,  the  epigastrium  was  slightly  sensi- 
tive to  pressure.  Examination  of  the  stomach  contents  after  a  test  break- 
fast showed  the  presence  of  free  hydrochloric  acid  with  an  acidity  of  78. 
Dr.  Einhorn's  diagnosis  was  neurasthenia  with  hyperchlorhydria,  and 
upon  his  advice  the  patient  w^as  given  a  more  liberal  diet  and  advised  to 
eat  more  rapidly.  In  three  weeks  he  gained  eleven  pounds  and  continued 
to  gain  in  weight  and  entirely  recovered.  The  difliculty  of  this  patient  in 
eating  and  swallowing  is  explained  by  the  psychic  excitement  subsequent 
to  the  sitophobia  and  bradyphagia. 

Tachyphagia — Tachyphagia,  or  hasty  eating,  is  a  common  evil.  The 
food  is  only  half  masticated  or  possibly  not  at  all,  and  enters  the  stomach 
without  being  properly  comminuted  and  insalivated.  Such  practice  will 
surely  lay  the  foundation  for  many  disorders  of  the  stomach  and  be  a  fruit- 
ful cause  of  intestinal  auto-intoxication.  Food  which  is  not  properly  com- 
minuted wnll  be  the  means  of  irritating  the  gastric  mucous  membrane  and 
will  not  be  sufficiently  acted  upon  by  the  gastric  juice  which  affects  only 
the  external  surface.  More  particularly  does  this  refer  to  the  digestion  of 
albuminoids.  Carbohydrate  foods  when  eaten  too  rapidly  enter  the  stom- 
ach with  only  slight  alteration,  due  to  the  rapidity  of  mastication  and 
swallowing,  wherein  the  ptyalin  of  the  saliva  is  not  present  in  sufficient 
quantities  to  produce  any  effect  on  the  preliminary  digestion  of  starches. 
The  chyme,  as  a  result  of  imperfect  mastication  and  imperfect  admixture 


EFFECT    OF    THE    MANNER    OF    EATING  85 

with  the  gastric  juices,  passes  out  through  the  duodenum  practically  un- 
changed and  is  liable  by  its  coarseness  to  produce  an  irritation  of  this 
organ. 

Tachyphagia  has  other  drawbacks  besides  the  mechanical  effect  just 
mentioned,  as  it  includes  the  taking  of  larger  quantities  of  food  in  too 
short  a  time  and  the  ingestion  of  foods  too  hot  or  too  cold.  In  observing 
the  proper  hygiene  of  eating,  provision  is  made  that  not  too  much  food 
passes  into  the  stomach  at  once,  for  mastication  requires  time;  besides^  in. 
dining  congenially,  some  time  is  spent  in  conversation  and  in  serving  of 
the  different  courses.  Food  that  is  too  hot  or  too  cold  has  its  temperature 
somewhat  equalized  by  the  slow  passage  through  the  mouth  and  esophagus. 
These  important  factors  are  not  observed  in  eating  too  rapidly.  It  is 
therefore  plain  to  the  careful  student  of  euphagia  that  in  too  rapid  eating 
an  unsuitable  quantity  of  food  at  unsuitable  temperatures  is  consumed; 
both  conditions  being  a  fruitful  cause  of  digestive  disturbances.  Tachy- 
phagia, or  too  rapid  eating,  is  a  frequent  fault,  causing  many  digestive 
qualms,  and  initiating  many  chronic  disorders  of  the  alimentary  canal. 
This  we  admit.  But  we  do  not  admit  the  necessity  for  slow,  deliberate 
and  systematic  mastication  as  a  sine  qua  non  for  health  in  every  indi- 
vidual, irrespective  of  temperament,  occupation  or  station  in  life;  nor  do 
we  believe  it  conducive  to  the  best  physiological  work  of  the  digestive 
organs  that  a  hard  and  fast  rule  be  enjoined  whereby  a  certain  stated 
period  of  time  must  be  devoted  to  mastication  regardless  of  the  nature  of 
the  food  or  the  pleasure  of  the  masticator. 

Evils  of  Overmastication — Insalivation  exerts  but  little  physiological 
effect  upon  the  protein  constituents  of  food.  According  to  the  teachings 
of  physiologists,  we  know  quite  well  that  either  the  pepsin  and  hydro- 
chloric acid  in  the  stomach  or  the  trypsin  beyond  will  take  care  of  the 
digestion  of  meats  provided  they  are  decently  comminuted  and  stay  in 
the  mouth  only  long  enough  to  originate  those  psychic  impulses  which 
Pavlov(8)  has  so  well  shown  us  regulate  the  subsequent  flow  of  the  di- 
gestive juices.  Every  observer  who  has  watched  carnivorous  animals  feed, 
knows  that  they  habitually  bolt  their  food,  and  zoological  history  records 
no  account  of  any  psychic  forms  of  dyspepsia  in  these  animals.  The  prin- 
cipal function  of  salivary  digestion  is  the  preliminary  transformation  of 
starch  into  maltose  by  the  action  of  ptyalin,  and  this  process,  though  in- 
augurated in  the  mouth,  continues  until  the  whole  of  the  stomach  content 
has  become  acid.  The  time  of  salivary  digestion,  though  quite  brief,  to 
be  effectual  should  be  energetic.  Primarily,  it  is  a  preliminary  act  and 
no  more  should  bo  expected  of  it  than  this.     The  pancreatic  and  other 


86  THE    HYGIENE    OF    EATING 

juices  beyond  the  pyloric  eud  of  the  stomach  will  take  care  of  the  diges- 
tion of  carbohydrates,  and  the  psychic  centers  will  forward  the  message 
regularly  and  rapidly  as  received  by  the  gustatory  senses. 

After  all,  we  might  say,  and  say  correctly,  the  rapidity  of  chewing  is 
temperamental.  We  all  know  that  some  people  can  perform  a  given  task, 
and  perform  it  well,  in  half  the  time  required  by  slow-moving  individuals 
who  do  everything  along  the  lines  of  least  resistance ;  and  as  some  people 
act  quickly,  speak  quickly  and  think  quickly,  they  also  chew  quickly  but 
well.  j\Ien  of  affairs  in  the  business  world,  those  engaged  in  professional 
activities,  soldiers,  statesmen,  and  what  not — ardent  and  strenuous  spirits 
— are  happiest  when  in  the  busy  turmoil  of  competitive  struggle;  with 
them,  the  act  of  mastication  is  naturally  performed  briskly  but  none  the 
less  adequately.  While  on  the  other  hand,  the  easy-going  meanderer,  who 
always  seeks  the  lines  of  least  resistance,  goes  through  life  in  a  leisurely, 
lackadaisical  way,  "far  from  the  maddening  world's  ignoble  strife."  To 
these  semivaletudinarians,  whose  gastronomic  functions  are  constantly 
under  severe  mental  scrutiny,  fletcherism  holds  out  promises  for  their  di- 
gestive and  intestinal  qualms. 

Time  is  too  precious,  and  life  too  short,  to  spend  an  unnecessary  part 
of  both  in  useless,  if  not  harmful,  mastication.  Fletcher  records  in  his 
writings  that  "one-fifth  of  an  ounce  of  a  young  onion  required  722  chews 
before  it  disappeared  through  involuntary  swallowing,"  and  Dr.  Kellogg 
records  the  history  of  a  patient  who  devoted  never  less  than  one  and  one- 
half  hours  in  partaking  and  masticating  his  one  scanty  daily  meal.  It  is 
preposterously  asinine  to  suggest  that  busy,  active  men — those  upon  whose 
shoulders  rest  the  burdens  and  perplexing  cares  of  government,  commerce 
and  science,  whose  bright  intellects  are  eagerly  conquering  the  earth,  the 
sea  and  the  air,  should  be  subjected  to  a  too  prolonged  and  wearisome  mas- 
tication which  is  a  snare  and  a  delusion — a  foolish  fad — an  anachronism 
in  our  twentieth  century  civilization. 

A  retired  business  man — cadaverous  looking  and  dyspeptic — consulted 
Niles(9),  informing  him  that  up  to  his  retirement  from  active  business, 
five  years  previous,  he  had  never  experienced  a  digestive  discomfort  dur- 
ing his  strenuous  years  of  laborious  business  activity.  He  hurriedly  ate 
his  breakfast  so  as  to  reach  his  office  betimes.  He  snatched  his  lunch  at 
a  near-by  restaurant,  and  his  evening  meal  or  dinner  was  frequently  rushed 
through  in  order  to  keep  some  important  business  or  social  engagement. 
The  subject  of  prolonged  and  tedious  mastication  had  never  entered  his 
mind,  ,nor  did  he  realize  that  he  was  "digging  his  grave  with  his  teeth," 
until  he  was  so  informed  by  an  over-zealous  acquaintance,  made  some  time 


EFFECT    OF    THE    MANNEli    OF    EATING  87 

after  his  retirement  from  business.  With  this  idea  implanted  in  his  idle 
mind,  and  with  little  else  to  do,  he  began  to  devote  himself  assiduously 
to  fletclierizing  his  food  as  a  safeguard  to  his  future  health.  Niles  reports 
that  as  a  result  of  too  nmcli  thought  given  to  his  digestive  organs,  there 
resulted  a  morbid  introspection  M^hich  gradually  transformed  a  robust, 
alert  business  man  into  a  puny,  whining  individual  full  of  pains  and  ob- 
sessions, whose  every  waking  thought  was  short-circuited  on  his  stomach. 

Napoleon (10)  at  35  years  had  developed  and  rounded  out  into  a  full- 
ness that  indicated  abounding  health  and  vigor,  and  at  the  same  time  his 
mental  faculties  had  reached  their  acme.  His  power  for  work  had  appar- 
ently never  been  equaled  by  any  other  man.  He  on  one  occasion  said 
there  was  no  limit  to  his  endurance..  Even  his  enemies  declared  that  his 
capacity  for  strenuous  work  equaled  that  of  four  men.  His  digestive 
powers  were  perfect.  He  preferred  plain  dishes  well  cooked,  his  meats 
browned,  and  he  rarely  spent  more  than  from  seven  to  twelve  minutes  at 
a  meal.  When  he  became  emperor  and  reached  the  pinnacle  of  his  suc- 
cess, like  many  other  successful  men,  he  began  to  pay  too  much  attention 
to  eating,  to  the  consideration  of  bodily  comfort,  and  less  attention  to  exer- 
cise. The  result  was  he  became  obese,  and  at  forty  his  physical  powers 
began  to  decline  and  his  grasp  on  the  world  slackened. 

In  Volume  I,  Chapter  V,  in  the  section  on  the  Chemistry  and  Physi- 
ology of  Digestion,  we  discussed  the  mechanical  and  chemical  changes 
occurring  in  the  stomach  and  intestines  during  digestion.  It  will  be  seen 
on  referring  to  this  section  that  each  division  of  the  alimentary  tract  has 
its  rightful  duties  in  the  life-scheme  of  nutrition,  and  the  magnification 
of  any  one  of  these  duties  is  liable  to  prove  an  opening  wedge  for  various 
digestive  ills,  which,  like  jealousy,  furnish  the  food  upon  which  they  feed 
and  thrive. 

Wo  are  of  the  opinion  that  Americans  eat  too  much  butcher's  meat  and 
comminuto  it  to  an  unnecessary  fineness  which,  according  to  our  theory, 
is  not  only  unessential,  but  contrary  to  nature.  All  carnivorous  animals 
bolt  their  meat,  and  we  have  no  recorded  observation  of  these  creatures 
suffering  from  any  form  of  digestive  disturbances.  In  the  first  place, 
meats  can  only  be  digested  in  an  acid  medium.  The  gastric  juices  of  tho 
stomach  are  markedly  acid,  and  it  is  necessary  for  meat  to  remain  in  the 
stomach  from  three  to  four  hours  or  longer  in  order  to  be  digested. 

Our  belief  is  that  meat  which  is  too  thoroughly  masticated  and  macer- 
ated will  be  forced  into  the  duodenum  before  the  acid  gastric  juices  of 
the  stomach  have  had  time  to  prepare  it  for  digestion.  It  is  well  known 
from  experience,  that  eating  sausage  or  hamburger  steak  produces  trouble 


88  THE    HYGIENE    OF    EATING 

during  the  process  of  digestion,  which  is  explained  in  this  way.  The  meat 
from  which  sausage  and  hamburger  steak  are  made  is  reduced  to  a  very 
fine  puip  with  a  machine,  and  when  it  enters  the  stomach,  it  does  not  re- 
main sufficiently  long  to  be  acted  upon  by  the  gastric  juices.  By  the  peri- 
staltic contractions  pointed  out  above,  it  is  forced  into  the  duodenum  too 
early,  and  as  a  result  of  not  being  properly  acted  upon  by  the  acid  gastric 
juices  and  reaching  an  alkaline  medium  in  the  duodenum  too  soon,  pro- 
tein digestion  is  hindered.  Consequently,  the  end  products  of  protein 
digestion  are  present,  throwing  extra  work  on  both  the  kidneys  and  liver, 
which  are  not  able  to  take  care  of  it.  Finally  these  same  end  products  of 
protein  digestion  are  reabsorbed  into  the  circulation,  producing  a  long 
chain  of  ill  results,  prominent  among  which  is — intestinal  intoxication. 

Major  W.  B.  Allen,  Medical  Corps  United  States  Army,  conducted  a 
very  interesting  series  of  experiments  which  he  related  to  the  writer  as  fol- 
lows: A  few  years  ago  a  company  of  men  under  his  direct  supervision, 
partaking  of  the  regular  United  States  Army  ration,  were  instructed  to 
bolt  their  meats,  Major  Allen  taking  careful  record  of  the  condition  of  the 
health  of  the  company  before  beginning  his  investigation.  He  very  care- 
fully watched  this  company  during  a  period  of  twelve  months,  having 
them  bolt  their  meat  during  this  period  of  time.  As  a  result  he  found 
that  this  company  of  men  had  fewer  sick  calls  than  any  other  company 
in  the  regiment.  They  were  more  free  from  bowel  disorders,  constipation, 
headache  and  digestive  disturbances  than  any  other  company  of  men  in 
the  battalion,  which  he  attributed  to  the  fact  that  they  did  not  chew  their 
meats  to  an  unnecessary  fineness.  This  observation  is  peculiarly  interest- 
ing and  of  value  in  emphasizing  the  foolish  fallacy  of  Fletcher's  fad. 

It  is  a  mistaken  idea  that  the  proper  hygiene  of  eating  means  "giving 
up  all  the  things  that  taste  good."  It  may  be  true  that  in  many  cases  sac- 
rifices are  made  in  reforming  one's  diet,  but  these  sacrifices  should  not 
decrease  the  enjoyment  of  food.  It  is  a  well-known  physiological  fact 
that  it  is  extremely  unhygienic  to  eat  foods  that  are  not  relished.  Foods 
must  have  a  pleasing  taste  and  flavor  and  must  be  enjoyed  in  order  to  be 
most  readily  assimilated.  Experiments  already  quoted  by  Pavlov  show 
that  the  taste  and  enjo^Tnent  of  food  stimulate  the  flow  of  the  various  di- 
gestive juices. 

THE  DRINKING  OF  WATER  WITH  MEALS 

A  moderate  amount  of  drinking  water  during  meals  is  not  objection- 
able. One  or  two  glassfuls  may  be  taken  with  impunity,  provided  it  is 
not  taken  when  food  is  in  the  mouth  and  used  for  washing  it  down.     A 


WATER    INGESTION  89 

moderate  amount  of  liquid,  from  250  to  500  c.c,  may  be  taken  without 
harm  at  each  meal  by  persons  in  good  health,  and  if  there  be  a  tendency 
to  accnimulation  of  mucus  or  lack  of  sufficient  secretion,  digestion  may 
occur  more  rapidly  when  liquid  is  used.  Physiologists  estimate  that  the 
stomach  contents  one  hour  after  a  meal  should  approximately  consist  of  50 
per  cent  water  that  can  be  removed  by  filtration. 

Hawk(ll )  has  shown  that,  when  water  drinking  accompanies  the  tak- 
ing of  food,  the  passage  of  water  is  delayed  somewhat.  His  experiments 
also  show  that  the  equivalents  of  from  one-half  to  three-quarters  of  the 
amount  of  water  ingested  during  a  meal,  if  this  amount  is  large,  may  be 
voided  in  the  urine  within  45  to  90  minutes  thereafter.  That  the  food  ele- 
ments were  not  thereby  washed  through  the  stomach  into  the  intestine  was 
shown  by  Cohnheim(12).  Along  the  smaller  curvature  there  is  formed 
a  trough  connecting  the  antrum  pylori  with  the  cardiac  opening,  and 
through  this  water  flows  past  the  bolus  of  food  lying  in  the  stomach  with- 
out washing  any  of  the  exterior  away.  Even  when  digestion  is  at  its 
height,  and  when  gastric  juice  is  being  secreted  in  large  quantities,  almost 
neutral  water  is  often  found  leaving  the  stomach.  Cohnheim  also  states 
that  there  is  no  dilution  of  the  stomach  contents  by  liquid  food,  and  the 
accurate  regulation  of  the  pyloric  sphincter  is  not  disturbed  whether  water 
is  taken  with  the  meal  or  not. 

From  this  brief  review  of  the  facts  regarding  the  drinking  of  water 
with  meals,  we  may  say : 

a.  The  ingestion  of  moderate  amounts  of  water  with  meals  not  only 
does  not  inhibit  the  normal  flow  of  digestive  juices,  but  acts  as  an  excitant 
to  their  flow. 

h.  The  digestive  juices  are  not  rendered  less  efficient  by  dihition,  but 
on  the  contrary,  the  greater  the  dilution,  the  more  complete  is  the  enzyme 
action  within  limits. 

c.  Even  if  the  food  were  washed  into  the  intestine  more  rapidly  than 
usual,  contrary  to  Cohnheim's  belief,  the  greater  efficiency  and  the  greater 
amount  of  the  digestive  juices  would  outbalance  this. 

PERSONAL   IDIOSYNCRASIES 

In  advising  proper,  well-balanced  dietaries,  personal  idiosyncrasies 
must  be  taken  into  account,  and  the  old  adage,  "what  is  one  man's  meat 
is  another  man's  poison,"  must  be  respected.  Again  individuals  have  a 
mistaken  idea  of  their  personal  idiosyncrasies;  many  people  asseverate 
that  nuts  do  not  agree  with  them,  when  the  trouble  really  is  in  the  want 
of  proper  mastication. 


00  THE    HYGIENE    OF    EATING 

In  the  succeeding  chapters  directions  will  be  given  to  help  the  physi- 
cian in  prescribing  a  well-balanced  dietary,  both  in  health  and  disease,  but 
it  will  be  difficult  to  formulate  any  rule  which  will  completely  insure  such 
a  choice.  Even  the  wisest  physiologist  cannot  depend  altogether  on  his 
knowledge  of  food  values. 

Sound  sleep  depends  somewhat  upon  previous  fatigue.  So  good  appe- 
tite, even  the  zest  for  some  particular  food,  follows  incipient  starvation. 
Thus  while  the  anabolic  processes  are  normally  nearly  always  the  same, 
so  as  to  supply  material  for  oxidation  and  repair  of  waste  as  needed,  occa- 
sional periods  of  moderate  shortage  do  no  harm  but  rather  stimulate  or- 
ganic vigor  and  economy. 

ORDER  AND  FREQUENCY  OF  MEALS 

The  ingestion  of  food  and  drink  should  be  intermittent,  since  they  are 
intended  to  provide  reserve  force  for  the  body.  The  supply  and  consump- 
tion of  nutrients  should  balance,  well-nigh  approximately  weekly  or  daily, 
except  where  it  is  advisable  to  remove  an  excess  or  supply  a  deficiency. 
It  is  even  deemed  advisable  to  have  the  separate  meals  correspond  as 
nearly  as  possible  to  the  demands  for  supplying  food  for  succeeding 
periods. 

Individuals  in  normal  health  should  have  three  meals  daily,  and  so 
should  patients  suffering  from  most  chronic  affections,  when  a  sufficient 
amount  of  food  can  be  taken  at  three  meals  for  proper  nutrition.  In  dis- 
eased coiiditions,  however,  it  will  be  seen,  as  outlined  in  Volume  Til, 
Chapter  I,  that  five  or  six  meals  are  more  desirable  and  much  more  readily 
digested,  and,  in  rare  cases  of  ulcer  of  the  stomach,  or  pernicious  anemia 
with  persistent  vomiting,  food  in  minute  quantities  must  be  given  as  often 
as  every  fifteen  or  twenty  minutes. 

Persons  engaged  in  heavy  manual  labor,  as  on  a  farm  or  in  a  lumber 
camp  or  in  railway  construction,  require  a  Hearty  breakfast,  a  solid  mid- 
day dinner  served  hot  and  a  light  supper  or  evening  meal.  Individuals 
engaged  in  this  class  of  labor  require(13)  : 

1.  Protein:  90  to  110  grams,  50  per  cent  to  be  from  animal  food;  or 
110  to  130  grams  if  only  one-third  of  the  protein  comes  from  animal  food. 

2.  Fat:  60  to  80  grams  if  the  food  contains  500  to  550  grams  carbo- 
hydrates ;  or  80  to  100  grams  if  the  food  contains  only  450  to  500  grams 
carbohydrates. 

3.  The  heat  content  of  the  food  should  be  2,900  to  3,300  calories.  No 
fixed  form  should  be  prescribed  for  the  food  taken,  because  persons  differ 
so  much  from  one  another  in  their  capacity  to  assimilate  certain  foods,  in 


OKDEli   AND    FUEQVKKCY    OF    MEALS  91 

their  physical  condition,  etc.  The  lower  figures  given  in  the  foregoing 
shoukl  be  considered  as  the  minimum,  while  the  higher  values  are  suffi- 
cient lor  the  energy  expenditures  of  strong  and  healthy  persons  engaged 
in  moderately  active  muscular  work. 

For  this  class  of  workers  the  breakfast  and  dinner  should  be  the  largest 
meals.  The  supper  or  evening  meal,  on  the  other  hand,  should  be  light 
and  easily  digested,  consisting  of  bread  and  milk,  or  other  cereal  food 
with  milk,  eggs  and  fruit,  so  that  the  stimulation  of  metabolic  products 
would  not  interfere  with  sleep,  and  thus  no  great  demand  for  innervation 
might  be  made  on  the  nervous  centers.  In  outlining  the  dietary  for  this 
class,  special  attention  should  be  given  to  this  evening  meal  for  the  reason 
that  a  full  bladder  and  especially  one  filled  with  urine  rich  in  waste  prod- 
ucts and  of  high  acidity,  will  interfere  with  sleep,  and  should  be  care- 
fully considered. 

Individuals  engaged  in  skilled  labor  not  involving  great  physical  or 
mental  fatigue  and  lasting  oidy  eight  hours  do  not  demand  the  hearty, 
warm  noon  dinner  required  by  the  individual  engaged  in  heavy  manual 
labor,  although  both  breakfast  and  luncheon  should  be  richer  in  carbo- 
hydrates and  fats  than  those  of  the  professional  and  business  man. 
Whether  the  evening  meal  is  called  supper  or  dinner,  it  should  be  essen- 
tially a  dinner,  served  hot  and  relatively  more  hearty  than  that  of  the 
strictly  manual  laborer. 

Individuals  engaged  in  professional  vocations,  rising  later  in  the  morn- 
ing and  going  to  bed  later  in  the  evening,  should  partake  of  a  light  break- 
fast consisting  largely  of  fruits  and  cereals  and  not  over  500  to  700  calo- 
ries. They  should  partake  of  a  slightly  heartier  luncheon  and  have  their 
principal  meal  at  the  close  of  the  day's  work,  allowing  four  or  five  hours 
for  its  digestion  before  retiring. 

Individuals  in  the  busy  marts  of  commercial  life,  whose  work  is  quite 
equally  divided  between  the  morning  and  afternoon,  and  whose  social  life 
is  relatively  simple,  should,  if  possible,  take  the  leisure  for  a  warm  noon 
meal,  with  a  sumptuous  dinner  in  the  early  evening.  They  require  a 
dietary  that  will  yield  from  2,800  to  3,000  calories  daily. 

For  persons  who  lead  a  life  of  leisure,  keeping  late  hours  at  night,  the 
most  convenient  arrangement  is  a  light  breakfast  of  fruit,  cereals,  possibly 
an  Ggg  with  coffee;  a  light  luncheon  about  midday;  and  a  dinner  at  five 
p.  m.,  with  a  light  supper,  not  too  unwholesome  and  with  very  little  stimu- 
lating beverage,  containing  either  xanthin  or  alcohol,  at  eleven  or  twelve 
in  the  evening. 

Ni(/1it  worhers  usually  go  to  bed  as  soon  as  possible  after  finishing 


92  THE    HYGIENE    OF    EATING 

their  allotted  task.  Manual  laborers  working  at  night  require  the  same 
arrangement  of  meals,  at  opposite  hours,  as  day  laborers.  Business  or 
professional  night  workers  usually  begin  and  close  their  work  at  relatively 
earlier  hours  in  the  evening  and  morning  than  corresponding  day  workers 
in  the  morning  and  afternoon,  respectively;  consequently,  they  have  more 
time  before  luncheon,  after  completing  their  sleep,  than  day  workers  have 
before  breakfast,  and  they  can  very  well  use  the  ordinary  luncheon  and 
dinner  and  take  a  light  supper  towards  the  close  of  the  night's  work. 

Heretofore  it  has  been  taught  that  a  full  stomach  is  a  protection 
against  prolonged  physical  and  mental  fatigue,  exposure  to  cold,  dampness 
and  infection.  This  is  true  in  the  sense  that  the  increased  demand  for 
nutriment  should  be  met  by  hearty  meals,  even  at  unusual  hours ;  but  it 
is  a  dangerous  fallacy,  if  construed  as  an  indication  for  overeating  or  for 
eating  at  too  short  intervals.  Coffee,  tea  and  chocolate  have  their  greatest 
value  and  alcoholic  beverages  their  greatest  danger  in  meeting  such  emer- 
gencies. In  Volume  I,  Chapter  XVI,  we  have  already  taken  occasion  to 
point  out  the  danger,  in  particular,  of  drinking  spirituous  liquors  before 
going  out  into  the  cold. 

REGULARITY    OF   MEALS 

It  is  an  indisputable  fact  that  regularity  in  partaking  of  meals  is  ad- 
vantageous, but  it  is  not  necessary  to  make  oneself  a  slave  to  the  clock  by 
insisting  on  minute  punctuality  for  mealtime.  It  is  not  wise  to  eat 
heartily  simply  because  it  is  mealtime,  in  the  absence  of  appetite ;  neither 
is  it  advisable  for  a  person  in  normal  health  to  skip  a  meal  unless  there 
is  some  derangement  of  the  digestive  organs.  Variety  in  diet  is  an  impor- 
tant factor  in  stimulating  the  appetite  and  digestive  secretions.  Variety, 
however,  does  not  necessitate  the  use  of  imported  or  expensive  foodstuffs. 
A  reasonable  degree  of  uniformity  in  diet  in  the  organic  nutrients  or  even 
in  the  groups  of  foodstuffs,  fats,  proteins,  carbohydrates,  etc.,  should  be 
followed,  but  the  different  varieties  of  bread  and  crackers,  meats,  fruits, 
etc.,  should  be  freely  used  with  different  methods  of  cooking  and  flavoring. 
The  benefit  ascribed  to  the  change  of  climate  and  scene  is  often  due  to  a 
change  of  food  and  cooking.  Frequently  perfectly  wholesome  and  even  ex- 
pensive and  well-cooked  foods  fail  to  fulfill  their  function,  simply  for  want 
of  ingenuity  on  the  part  of  the  cook  to  afford  variety  and  pleasing  flavor. 

It  is  regrettable  that  an  absurd  custom  has  been  inaugurated  in  Amer- 
ica of  omitting  breakfast,  or  of  taking  only  coffee  and  a  roll.  This  habit 
was  introduced  by  Americans  who  had  traveled  in  France,  where  this 
absurd  custom  exists, 


SLEEP    A:SD   digestion  93 


SLEEP   AND   DIGESTION 


The  young  infant  should  spend  the  greater  part  of  his  time  in  sleep, 
awakening  only  to  take  nourishment  and  remaining  awake  but  a  short 
period  of  time  necessary  for  exercise.  During  the  second  and  third  years, 
the  child  recpiires  about  fourteen  hours'  sleep,  gradually  reduced  to  twelve 
by  the  eighth  or  tenth  year  and  to  ten  hours  at  the  close  of  adolescence. 
For  detailed  information  pertaining  to  diet  and  sleep  at  different  ages  and 
physiological  periods,  the  reader  is  referred  to  Volume  II,  Chapter  XI. 

During  active  adult  life  the  amount  of  sleep  depends  to  some  extent 
upon  heredity  and  bodily  vigor,  but  largely  on  the  severity  of  mental  and 
physical  activity ;  it  is  greatest  in  youth  and  least  in  old  age.  The 
overworked  medical  student  requires  more  sleep  than  most  other  profes- 
sional students,  or  than  the  average  college  student.  For  severe  mental 
and  manual  labor,  ten  hours'  sleep  are  usually  required.  Light  physical 
labor,  routine  clerical  work  and  easy  professional  occupations  require  only 
seven  or  eight  hours'  sleep. 

Sleep  favors  digestion  and  allows  time  for  its  chemical  process  to  be 
completed  before  the  next  meal,  so  that  appetite  is  awakened.  There- 
fore, from  a  physiological  point  of  view,  the  proper  time  for  the  largest 
meal  for  farmers  and  mechanics  is  in  the  early  part  of  the  day,  because  a 
hearty  supper  ingested  the  evening  before  is  out  of  the  stomach  by  mid- 
night and  the  digestive  organs  have  had  eight  hours'  rest  before  8  a.  m., 
when  the  logical  time  for  a  hearty  meal  occurs.  Farmers  and  those  en- 
gaged in  manual  labor,  mechanics  and  others,  are  accustomed  to  have  a 
very  heavy,  substantial  breakfast. 

It  is  a  fact  well  known  that  eating  a  heavy  meal  brings  about  a  degree 
of  hebetude  by  diverting  the  blood  from  the  brain  to  the  stomach,  and 
therefore,  one  should  not  retire  until  two  or  three  hours  after  eating  a 
hearty  dinner.  If  an  individual  retires  four  or  five  hours  after  dinner, 
he  will  be  able  to  get  along  very  well  with  six  or  seven  hours'  sleep,  but 
if  he  goes  to  bed  immediately  after  a  hearty  meal,  he  usually  requires  from 
eight  to  ten  hours'  sleep. 

The  metabolic  processes  of  the  body  are  least  active  during  quiet,  deep 
sleep.  During  sleep  the  body  rests,  which  is  often  quite  as  necessary  for 
healthy  digestion  as  sleep  itself;  indeed,  the  great  tax  upon  the  digestive 
organs  for  metabolizing  the  full  meal  is  little  appreciated,  judging  from 
the  strenuous  physici^l  and  mental  stunts  performed  by  some  people  imme- 
diately after  eating.  We  all  realizie  that  sound  sleep  often  dissipates  in- 
digestion.    For  the  performance  of  the  proper  physiological  functions  of 


SNt  THE    HYGIEXE    OF    EATING 

the  digestive  organs  much  blood  is  required,  which  is  not  usually  com- 
patible with  full  functional  activity  either  of  the  brain  or  the  muscles. 
Physicians  have  found  that,  for  this  reason,  a  brief  rest  after  each  meal 
contributes  largely  to  its  digestion.  Pavlov  and  other  physiologists 
have  proven  bejond  doubt,  by  producing  artificial  fistulas  in  the  various 
organs  of  animals,  that  an  enormous  amount  of  blood  is  directed  from  the 
periphery  of  the  body  to  the  digestive  organs,  and  that  the  respective  di- 
gestive juices  are  secreted  in  greater  abundance  and  with  greater  rapid- 
ity during  the  normal  digestive  process.  From  habit,  the  system  becomes 
accustomed  to  fairly  active  physical  exertion  and  even  to  engrossing  men- 
tal activity  after  a  moderate  meal.  Yet  for  one's  well-being  it  is  advis- 
able to  eat  two  or  three  hours  before  any  exceptional  strenuous  physical 
exertion  or  difficult  mental  application  is  undertaken  and  to  rest  or  even 
take  a  nap  after  a  hearty  meal,  and  not  to  eat  too  heartily  just  before 
retiring. 

OCCUPATION    AND   DIGESTION 

We  had  occasion  in  the  early  part  of  this  chapter  to  refer  to  work  as 
stimulating  appetite  and  digestion.  It  is  known  that  agreeable  occupa- 
tion stimulates  ambition,  creates  the  healthy  habit  of  thinking  and  study, 
and  leads  to  optimism  which  in  turn  promotes  good  digestion.  We  all 
know  that  the  worst  dyspeptics  are  the  disgruntled  and  pessimistic  indi- 
viduals who  have  nothing  to  do  but  to  eternally  bore  their  friends  by  out- 
lining their  ills.  Many  of  this  class  do  not  work  because  some  relative's 
icill  left  them  in  affluence.  Some  of  these  affluent  individuals  spend  their 
time  wnth  sports,  while  others,  devoid  of  all  sporting  proclivities,  readily 
develop  dyspepsia,  hypochondria  and  melancholia.  The  former  would  be 
far  healthier  and  happier  if  a  part  of  their  time  were  occupied  in  some 
useful  vocation ;  others  follow  no  vocation  because  the  compensation  is  in- 
adequate or  their  services  are  not  sought,  or  they  fail  to  find  the  kind  of 
work  for  which  they  are  best  adapted.  It  is  apparent  to  the  thinking 
physician  that  psychical  and  dietetic  treatment  for  this  class  of  patients 
is  far  preferable  to  the  customary  wholesale  administration  of  dyspeptic 
and  nervine  remedies  which  not  only  do  no  good,  but,  beyond  doubt,  are 
harmful  by  their  chemical  action  in  the  system. 

VARIETY   IN  DIET 

Monotony  in  diet  does  not  augment  appetite  nor  facilitate  digestion. 
This  is  emphasized  bv  Barr  in  his  published  results  on  the  monotonous 


VARIETY    IN    DIET  95 

feeding  of  prisoners.  He  says  the  coutiuued  serving  of  one  kind  of  food 
in  one  way  causes  loss  of  appetite,  vomiting,  flatulence,  diarrhea  or  ob- 
stinate constipation.  The  great  Shakespere  said:  "Let  good  digestion 
wait  on  appetite  and  health  on  both." 

It  is  a  mistaken  idea  to  bring  up  children  without  teaching  and  train- 
ing them  to  eat  all  kinds  of  foods.  It  is  likewise  a  mistake  to  say  that  a 
boy  or  girl  at  puberty,  or  an  individvial  in  adult  life  or  even  old  age,  is 
too  old  to  acquire  a  liking  or  appetite  for  a  particular  kind  of  food  that 
he  has  never  tasted,  or  even  a  food  that  he  became  disgusted  with  years 
before,  perhaps  because  of  partaking  too  freely  of  it. 

We  have  already  had  occasion  to  point  out  the  reasons  for  variety  in 
diet.  We  wish  to  emphasize  them  again:  First,  to  make  it  possible  for 
individuals  to  live  in  any  part  of  the  world ;  second,  to  enable  them  to 
have  a  greater  variety  of  food  which  permits  of  a  better  balanced  ration; 
third,  to  inculcate  the  habit  of  eating  different  foods  in  youth ;  fourth,  to 
enable  them  to  enjoy  meals  while  traveling  and  sight-seeing;  fifth,  to  en- 
hance their  chance  to  recover  from  illness  by  being  able  to  partake  of  a 
greater  variety  of  nourishment.  Older  persons  should  be  persuaded  to 
cultivate  an  appetite  for  all  kinds  of  wholesome  food  and  not  be  content 
with  one  method  of  preparation.  They  should  familiarize  themselves  with 
different  methods  of  cookery,  as  the  greater  the  variety,  the  better  the  ap- 
petite, and  the  more  monotonous  the  fare,  the  poorer  the  appetite. 

An  elaborate  dinner  usually  consists  of  a  double  meal,  the  soups  and 
entrees  coming  first,  the  "good  things"  last.  The  first  dessert  is  repre- 
sented by  compotes,  sherbet,  etc.  Such  meals  are  usually  too  elaborate 
and  often  represent  an  entire  day's  ration.  "Good  things"  are  on  the 
whole  richer  in  caloric  value  than  the  plainer  or  substantial  foods.  An 
ice  cream  soda  or  sundae  (sondhi)  contains  from  200  to  400  calories;  a 
half  pound  of  candy,  about  000  calories ;  a  half  pint  of  unshelled  peanuts 
or  almonds,  000  calories.  Either  of  the  latter  also  furnishes  about  20 
grams  of  protein,  a  third  of  a  day's  ration.  The  intelligent  laity  and  even 
physicians  fail  to  realize  that  allowance  should  be  made  for  such  indul- 
gence in  the  ration  for  the  regular  meals. 

There  is  probably  much  truth  in  the  belief  that  normal  appetite  forms 
a  reasonable  index  of  the  dietetic  needs  for  metabolism.  If  individuals 
free  from  digestive  disturbances  maintain  a  practically  constant  weight 
and  a  slight  surplus  of  energy  in  a  form  of  panniculus  adiposus,  without 
being  too  stout  or  too  thin,  it  is  not  imreasonable  to  believe  that  their 
dietetic  habits  are  not  far  removed  from  the  metabolic  needs  of  their 
bodies. 


96  THE    HYGIENE    OF   EATING 

In  this  chapter  we  have  endeavored  to  point  out  the  necessity  for  the 
use  of  proper  quality  and  quantity  of  food  needs,  and  the  absolute  neces- 
sity of  supplementing  these  by  other  accessory  adjuncts  to  good  digestion, 
in  order  to  secure  the  best  results. 

We  pointed  out  in  the  preceding  chapter,  Analyses  and  Cooking  of 
Foods,  the  reason  for  proper  attention  to  the  culinary  art  as  well  as  the 
reason  for  the  selection  of  proper  variety,  quality  and  quantity  of  food- 
stuffs. The  illustrative  tables  on  analyses  of  foods  in  Volume  I,  Chapter 
XIX,  are  very  extensive  and  complete,  giving  the  protein,  fat,  carbo- 
hydrate, ash,  fiber  and  water  content  of  every  known  article  of  food. 
These  tables  also  show  the  caloric  value  per  pound  and  per  portion,  so 
arranged  that  the  physician  or  dietitian  can,  with  ease  and  rapidity,  pre- 
scribe a  variety  of  diet  either  in  health  or  for  certain  diseased  conditions, 
and  can  at  a  glance  know  the  caloric  content  of  the  ration. 

In  the  ensuing  chapters  of  this  work,  the  scientific  application  of 
trophotherapy  to  the  general  principles  of  nutrition  both  in  health  and 
in  diseased  conditions  will  be  gone  into  very  exhaustively.  The  reasons 
for  subjecting  patients  suffering  from  various  diseases  to  a  strict  dietetic 
therapy  will  be  taken  up,  and  the  science  of  sitology,  particularly  as  to 
the  therapeutic  value  of  foods  in  disease,  explained.  The  apparent  same- 
ness of  diet  in  many  affections  is  not  real,  as  will  be  seen  in  the  large 
number  of  foods  allowed  containing  protein,  carbohydrates  and  fat.  The 
percentage  of  each  element  allowed  in  every  case  is  not  stated,  because  it 
must  vary  with  the  patient  and  can  be  safely  left  for  the  physician  to  pre- 
scribe after  he  has  familiarized  himself  with  food  values  and  has  studied 
the  case. 

RELATION    OF   MEDICATION   TO    MEALS 

Before  closing  this  chapter,  the  author  deems  it  advisable  to  refer  to 
the  relation  of  medication  to  meals.  The  directions  and  rules  incorpo- 
rated herewith  for  prescribing  certain  medicines  before  meals,  certain 
other  medicines  immediately  after  meals,  and  others  one  or  two  hours 
after  meals,  are  based  almost  entirely  on  the  writings  of  Dr.  A.  L. 
Benedict  (1). 

Ordinarily,  acids  should  be  given  before  meals,  especially  when  given 
to  promote  secretion  of  hydrochloric  acid.  It  is  well  to  bear  in  mind  that 
half  an  hour  should  be  allowed  for  their  passage  into  the  intestines  before 
the  meal  is  begun.  If  alkalies  are  used  to  reduce  gastric  acidity,  they 
should  be  given  one  hour  or  more  after  the  ingestion  of  the  meal,  and  in 
some  instances  they  should  be  repeated  in  divided  doses.     Alkalies  when 


KELATiOX    OF    MEJJiUATiOiY    TO    MEALS  97 

given  for  this  purpose  should  be  prescribed  in  tlie  form  of  carbonates. 
Some  clinicians  make  a  common  error  of  regarding  neutral  salts  of  alka- 
line metals  as  alkalies.  When  there  is  a  deficiency  of  hydrochloric  acidity, 
hydrochloric  acid  should  seldom  be  given  less  than  an  hour  after  meals,  in 
order  to  permit  the  stomach  to  do  what  it  can  in  this  direction  and  some- 
times acids  are  needed  in  several  divided  doses  given  at  intervals  of  half 
an  hour.  It  should  be  borne  in  mind  that  acids  must  not  be  given  after 
the  stomach  has  emptied  itself.  The  practice  of  prescribing  hydrochloric 
acid  before  meals  to  reduce  hypochlorhydria  is  useless. 

Simple  bitters  and  other  remedies  used  to  spur  on  a  flagging  appetite 
or  to  stimulate  gastric  secretion  should  be  given  shortly  before  meals. 
Drugs  which  exert  local  irritant  action,  unless  for  some  special  reason, 
should  be  given  during  or  after  a  meal  in  order  to  secure  dilution  and 
thorough  admixture  with  the  stomach  contents.  Drugs  intended  to  exert 
a  local  action  on  the  stomach,  as  bismuth,  emulsions  of  bismuth,  etc., 
should  be  given  three  or  four  hours  after  a  meal  and  the  interval  between 
meals  should  be  lengthened  as  much  as  possible  to  allow  sufficient  time  for 
their  action.  Drugs  which  exert  a  nauseating  action  should  be  given  on  a 
full  stomach  immediately  after  a  meal,  provided  the  physician  desires  to 
prevent  their  nauseating  effect ;  otherwise  they  should  be  given  on  an 
empty  stomach.  Remedies  intended  to  exert  their  action  mainly  on  the 
intestinal  tract  should  be  given  about  three  hours  after  a  meal,  and  in  cap- 
sule form  if  they  are  decomposed  by  the  gastric  juice.  Ordinarily,  gela- 
tin capsules  do  not  dissolve  within  an  hour,  but  salol  or  keratin  coatings 
may  be  employed  for  pancreatin,  etc.  Many  substances,  such  as  salol, 
salacetol,  iodipin,  etc.,  are  not  acted  upon  in  any  degree  in  the  stomach 
and  hence  may  be  given  immediately  after  a  meal. 

Saline  cathartics  and  purgative  mineral  waters  usually  act  more  ener- 
gcti(!ally  if  taken  half  an  hour  or  so  before  breakfast  or  before  other  meals, 
and  may  fail  if  given  at  night  when  the  patient  is  about  to  retire.  Other 
cathartics  intended  to  act  from  a  single  dose  are  best  given  just  before 
retiring.  Laxatives  when  used  regularly  are  usually  given  in  small  dos- 
age, preferably  with  meals,  whether  before  or  after  being  a  matter  of  in- 
difference, unless  their  administration  before  meals  should  hinder  appe- 
tite.    Under  such  circumstances  they  should  be  given  after  meals. 

Corrosive  medicines  of  all  kinds,  including  the  mineral  acids  and 
salts,  should  be  well  diluted  and  drunk  through  a  tube,  or  the  tongue 
should  be  used  as  a  trough  and  the  mouth  should  be  immediately  rinsed 
in  either  case,  preferably  with  a  dilute  alkaline  solution  of  soda  or  borax. 

Quinine  and  other  bitter  drugs  may  be  given  with  chocolate  to  dis- 


98  THE    HYGIENE    OF    EATING 

guise  the  taste.  Jam,  apple  sauce,  etc.,  may  be  used  to  disguise  the  taste 
of  some  medicines. 

The  iodids  aud  salicylates  may  be  given  in  milk.  The  iron  salts  should 
be  preferably  administered  in  sirups,  never  in  mucilages,  both  to  disguise 
the  taste  and  prevent  corrosion.  Castor  oil  may  be  given  in  whiskey,  milk 
or  fruit  juices  or  after  salt  has  been  placed  on  the  tongue. 

Since  the  digestion  of  fats  and  oils  takes  place  only  after  saponifica- 
tion, cod  liver  oil  should  not  be  given  until  one  and  a  half  hours  after 
meals. 

The  food  and  digestive  juices  contain  various  substances  more  or  less 
incompatible  with  certain  medicines;  for  example,  starch  with  iodin, 
hydrochloric  acid  with  calomel,  hydrochloric  acid,  proteins  and  mucin 
with  silver  salts ;  tannin  with  alkaloids,  iron  and  various  other  substances, 
and  gummy  substances  with  iron.  To  what  degree  these  incompatibilities 
are  of  consequence,  or  how  far  they  can  be  avoided,  must  be  considered  in 
each  case,  and  for  further  information  pertaining  to  these  incompatibili- 
ties, the  reader  is  referred  to  the  various  text-books  on  Materia  Medica 
and  Therapeutics. 

.  REFERENCES 

1.  Benedict,  A.  L.     Golden  Rules  of  Dietetics. 

2.  Canxox.     Bodily  Changes  in  Pain,  Hunger,  Fear  and  Rage,  pub. 

by  D.  Appleton  &  Co.,  1915. 

3.  I.EA,  Henry  Charles.     Superstition  and  Force,  Philadelphia. 

4.  Oechsler.     Internat.   Beitr.   z.   Path.   u.   Therap.   d.   Ernahrungs- 

storungen,  1914,  vol.  v,  p.  1. 

5.  AuER.     J.  Am.  Med.  Assn. 

6.  Fletcher,  Horace.     The  A  B  C  of  Nutrition,  New  York. 

7.  EiNHORN.     New  York  Med.  J.,  Jan.  7,  1905. 
.    N.  Y.  Med.  J.,  Jan.  7,  1905. 

8.  Pavlov,  Ivan   Petrgvicii.     The  Work  of  the  Digestive  Glands, 

translation  by  Thompson,  1902. 

9.  NiLEs,  Geo.  M.     J.  Am.  Med.  Assn.,  March  29,  1913. 

10.  Editorial,  New  York  Med.  J.,  June,  1915. 

11.  Hawk.     J.  Am.  Chem.  Soc,  1911,  vol.  xxxiii,  1909. 

12.  CoHNHEiM.     Miinch.  med.  Wochnschr.,  1907,  54,  2581. 

13.  GiGON  (of  Basel).     Monthly  Review  of  the  U.  S.  Labor  Statistics, 

vol.  i.  No.  2. 


CHAPTER    V 

VARIOUS  FACTORS  BEARING  O^  DIET,  DIGESTION  AND 

ASSIMILATION 

IN    COLLABORATION    WITH 

A.  L.  Benedict,  A.M.,  M.D.,  F.A.C.P. 

The  universe  is  naught  but  by  life,  and  all  that  lives  is  nourished. 

Transmntability  and  Reservation  of  Foods. 

Waste  and  Digestibility  of  Foodstuffs. 

Substitutes  for  Food. 

Starvation  and  Inanition :   Starvation ;   Inanition. 

Fasting:  Fasting  in  Religion;  No-Breakfast  Plan;  Fasting  as  a  Cure; 
Long-continued  Undernutrition;  Fasting  Experiments;  Effect  of  Fast- 
ing on  Metabolism, 

Perversion  of  Appetite:  Parorexia,  Anorexia,  Bulimia,  Polyphagia, 
Akoria,  Polydipsia,  Rumination,  Merycism,  Vomiting,  Hiccough, 
Aerophagia,   Seasickness. 

TRANSMUTABILITY  AND  RESERVATION  OF  FOODS 

From  a  careful  study  of  the  elements  of  foods,  it  is  evident  that  one 
kind  of  food  cannot  be  transmuted  into  a  totally  different  kind.  While 
we  know  that  one  saline  may,  to  a  slight  degree,  replace  another  in  osmotic 
phenomena,  and  that  even  hydrochloric  acid  may  be  replaced  by  other 
strong  acids  in  gastric  digestion,  yet  sodium  cannot  entirely  take 
the  place  of  potassium,  nor  is  it  possible,  because  of  its  greater  toxicity, 
for  potassium  to  supplant  sodium  to  any  great  degree.  The  calcium  salts, 
being  insoluble,  are  peculiarly  adapted  to  the  growth  and  development  of 
the  skeleton,  and  while  magnesium  salts  are  more  or  less  associated  with 
the  calcium  salts,  they  cannot  be  substituted  for  each  other  to  any  great 
extent.  It  is  unnecessary  to  repeat  similar  citations  for  the  various  inor- 
ganic constituents  of  tlie  body.  This  and  the  following  paragraph  are 
based  largely  on  Chapter  VI  of  Benedict's  "Golden  Rules  of  Dietetics" 
(Mosby  Co.). 

99 


100    FACTORS  IN  DIET,   DIGESTIOJT  AND   ASSIMILATION 

Wheu  the  various  essential  foodstutts  are  administered  in  sutticient 
amount  to  furnish  the  requisite  calories,  and  in  a  condition  available  for 
absorption  and  assimilation,  it  does  not  matter  particularly  in  just  what 
natural  combinations  they  are  employed.  It  is  possible,  though  not  always 
advisable,  to  replace  water  by  substituting  quantities  of  the  various  bev- 
erages and  semisolid  or  solid  foods  containing  it.  During  a  twenty-four- 
hour  period  about  200  c.c.  of  water  is  evolved  in  the  system  from  the 
oxidation  of  hydrogen  in  organic  combination,  especially  from  the  carbo- 
hydrates, but  also,  to  some  extent,  from  fats  and  proteins.  Therefore  we 
may  safely  assert  that  no  one  natural  foodstuff  or  group  of  foodstuffs  is 
indispensable,  or  even  particularly  requisite  for  good  nutrition,  with  per- 
haps the  exception  of  milk  in  the  case  of  infants.  It  is  admitted  that  one 
may  live  on  a  strict  vegetable  diet  for  a  protracted,  if  not  for  an  indefinite, 
period,  yet  the  entire  absence  of  animal  proteins  is  not  conducive  to  a 
perfect  state  of  health.  Practically  there  is  no  essential  difference  between 
animal  and  vegetable  protein,  yet  there  seems  to  be  a  something  in  ani- 
mal protein  that  is  not  supplied  by  vegetable  protein.  Physiologists  have 
been  able  to  note  that  different  individuals  seem  to  reach  their  optimum 
on  different  proportions  of  animal  and  vegetable  protein,  and  even  on 
different  proportionate  uses  of  different  groups  of  flesh,  as  that  of  quad- 
rupeds, fish  and  fowl,  or  of  different  species  of  meat,  as  beef,  mutton, 
pork,  etc. 

Theoretically,  it  is  possible,  and  even  practical,  to  replace  the  hydro- 
carbons with  proteins  and  carbohydrates,  without  serious  detriment  to 
the  human  organism,  as  obviously  no  one  particular  kind  of  fat,  as 
olein,-  palmitin  or  stearin,  is  indispensable;  besides,  these  different  va- 
rieties appear  to  serve  a  similar  purpose,  with  the  exception  of  stearin, 
which  requires  relatively  more  to  replace  the  others  progressively.  So 
to  a  considerable  extent  the  precise  chemical  nature  of  the  deposited  fat  of 
an  animal  depends  largely  upon  its  diet,  which  may  even  be  modified  by 
artificial  limitation.  For  instance,  the  fat  of  a  hog,  fed  on  corn  and  meal, 
will  be  white,  firm  and  quite  different  from  that  of  a  hog  fattened  on 
slops  and  swill,  so  it  is  not  improbable  that  the  diet  is  relatively  of  great 
importance,  and  it  is  not  at  all  unlikely  that  the  yellow  color  of  human 
fat  is  due,  in  part,  to  the  large  consumption  of  flesh  and  butter  and  a 
variety  of  natural  pigments  occurring  in  foodstuffs.  The  difference  in 
the  calorie  value  of  the  various  varieties  of  fats  and  of  carbohydrates  is 
slight,  scarcely  sufficient  to  warrant  the  exact  studies  of  calorimetry, 
owing  to  the  preponderance  of  many  sources  of  error. 

We  learned  when  studying  the  proximate  principles  of  foods  in  Vol- 


TEANSMUTABILITY  A^D  RESERVATION  OF  FOODS    101 

unie  I,  Chapter  111,  that  all  assimilable  carbohydrates  are  ultimately 
broken  down  into  simple  hexoses,  and  more  often  into  dextrose.  Dur- 
ing the  first  year  of  life  the  child  uses  lactose  almost  entirely,  though 
it  can  digest  a  small  amount  of  starches  during  early  infancy  (1).  Later 
in  life  the  individual  appetites  for  starches  and  sugars  respectively  are 
markedly  different;  therefore,  it  is  extremely  difficult  to  state  just  how 
far  these  are  physiologically  interchangeable,  and  especially  to  calcu- 
late the  exact  available  energy  of  any  one  sugar  in  the  process  of 
nutrition.  Practical  experience  coupled  with  animal  experimentation 
emphasizes  the  fact  that  the  various  sugars  do  not  furnish  desirable  sub- 
ptiliites  for  starch.  The  reasons  for  the  non-transmutability  of  sugars  and 
starches  are  (a)  that  the  former  when  ingested  in  large  quantities  produce 
irritatiou  of  the  mucous  membrane,  (b)  cause  fermentation,  (c)  and  by 
overtaxing  the  glycogenic  function  of  the  liver  allow  a  leakage  of  sugar 
into  the  circulation,  (d)  Besides  there  may  possibly  be  other  abstruse 
reasons. 

Experience  confirms  the  fact  that  individuals  who  partake  freely  of 
cereals,  potatoes,  breadstuffs,  etc.,  crave  little  sugar  and  vice  versa,  while 
the  individual  appetite  for  carbohydrates  generally  is  inverse  to  that  for 
hydrocarbons  and  proteins  respectively  and  together,  and  that  appetite  for 
all  food  varies  with  the  individual  and  with  the  season.  The  craving 
for  sugar  is  not  always  due  to  a  luxurious  habit,  though  it  may  de]>end 
upon  a  relative,  but  still  not  an  abnormal,  weakness  of  digestive  ferments, 
or  even  upon  abnormalities  of  the  intestinal  canal.  The  consumption  of 
sugar  has  increased  considerably  during  the  past  two  or  three  decades, 
commensurate  with  the  growth  of  the  cane  and  sugar  beet  industries 
(see  Volume  I,  Chapter  XVII,  Sugar,  Spices  and  Condiments),  also 
with  the  increasing  magnitude  of  the  culinary  and  confectioner's  art. 
Benedict  says,  "An  individual  in  normal  health  may  ingest  with  impunity 
100  grams  a  day  of  carbohydrates  in  the  form  of  sugar,  while  certain 
persons  may  take  double  this  quantity  without  harm." 

Hydrocarbons  are  theoretically  replaceable  by  other  organic  foods 
and  even  absolute  fat-free  diets  may  be  allowed  without  harm,  but  the 
same  statement  cannot  be  made  for  carbohydrates.  It  is  a  known  physio- 
logical impossibility  for  the  system  to  digest  and  absorb  more  than  a 
given  definite  maximum  of  fats,  and  80  grams  of  carbohydrate  are  re- 
quired to  prevent  catabolic  disturbances.  We  know  that  a  too  liberal 
allowance  of  meats  induces  an  inevitable  increase  of  nitrogenous  waste 
products  from  the  vicarious  use  of  proteins. 

Proteins,  unlike  carbohydrates  and  hydrocarbons,  are  employed,  not 


102    FACTORS  IN  DIET,   DIGESTIOJ^  AND   ASSIMILATION 

only  to  furnish  heat  and  energy,  but  to  replace  wear  and  tear  of  the 
tissues.  They  are  positively  non-replaceable,  beyond  a  certain  percent- 
age, by  either  carbohydrates  or  fats,  or  even  non-protein  nitrogenous 
substances,  such  as  gelatin  and  purins,  free  or  combined.  However,  it 
should  be  borne  in  mind  that  beyond  the  minimum  of  60  to  100  grams  a 
clay  (the  precise  standard  being  an  unsettled  question),  proteins  should 
be  replaced  by  carbohydrates  and  hydrocarbons,  provided,  of  course,  there 
is  no  metabolic  disturbance  such  as  diabetes  and  obesity.  We  know  that 
within  the  system  both  the  protein  and  carbohydrates  may  be  trans- 
muted into  fat  and  so  deposited.  Physiology  definitely  proves  that 
dextrose  and  glycogen  may  be  formed  from  fat  or  protein,  and  possibly 
from  both.  There  is  a  popnlar  idea  that  much  energy  may  be  accumu- 
lated by  the  excessive  ingestion  of  foods,  which  is  partially  true,  but 
the  importance  of  this  notion  lies  in  the  fact  that  it  leads  to  over- 
eating. 

Deposited  fat  is  the  only  evidence  that  a  reserve  energy  of  any  im- 
portance is  accumulated.  The  human  body  may  put  on  100  pounds  of 
fat,  or  over  400,000  calories  in  potential  energy,  or  the  requisite  amount 
to  sustain  the  body  for  200  days.  Such  a  demand  rarely  happens  in 
civilized  life,  and  if  so  the  body  certainly  would  lack  the  power  to  utilize 
it,  even  with  concomitant  waste  of  protein  tissue.  There  is  no  recorded 
case  where  the  body  reserve  energy  has  lasted  more  than  about  forty  days 
without  a  supply  of  organic  nutriment  from  without. 

Carbohydrates  may  be  stored  in  the  body  as  dextrose  in  solution,  and 
as  glycogen  in  muscular  tissue  and  gland  cells,  particularly  in  the  liver, 
to  the  extent  of  300  grams  per  day,  just  barely  enough  to  supply  a  half 
day's  caloric  demands  for  the  regulative  functions. 

In  studying  Protein  and  Nutrition  (see  Volume  II,  Chapter  VII), 
the  researches  of  Chittenden,  Fischer  and  others  give  proof  that  a  small 
amount  of  protein  in  excess  of  the  daily  requirement  for  needed  calories 
may  be  stored.  Voit  and  other  investigators,  experimenting  with  dogs, 
conclude  that  the  proportionate  storage  is  between  5  and  8.5  per  cent. 
Von  Noorden(2)  estimates  that  the  human  being  can  store  about  10  per 
cent  of  the  excess  protein.  So  we  may  safely  conclude  that  the  energy 
eliminated  from  metabolized  protein  will  aggregate  about  90  per  cent, 
and  the  stored  protein  will  be  in  the  neighborhood  of  10  per  cent  of  the 
amount  ingested.  In  addition,  it  must  be  remembered  that  a  small 
moiety  of  reserve  protein  occurs  in  the  circulatory  and  lymphatic  systems, 
M'hile  the  remainder  is  stored  in  hypertrophic  or  in  newly  formed  colls. 
So  much  protein  is  required  to  supply  the  wear  and  tear  of  normal  mus- 


WASTE    AND    DIGESTIBILITY    OF    FOODSTUFFS     103 

cular  tissues  that  only  a  very  small  amount  can  be  stored  as  a  reserve 
available  in  starvation  or  relative  inanition. 

From  the  foregoing  we  may  arrive  at  the  following  conclusions : 

(a)  It  is  useless  to  increase  the  protein  ration  to  create  a  reserve 
of  force  and  tissue  material,  since  such  a  course  overtaxes 
the  organs  of  excretion  and  increases  the  chances  of  anto- 
intoxication. 

(6)  It  is  not,  at  present,  an  accepted  fact  that  only  the  protein 
minimum — just  enough  to  balance  the  nitrogen  equilibriiun 
— is  the  ideal  ration.  The  proper  nutrients  for  a  normal 
body  amount  to  at  least  three  meals  a  day  of  a  standard 
dietary.      (Volume  II,  Chapter  VII.) 

(c)  The  storage  of  hydrocarbons  in  persons  of  small  stature 
should  not  exceed  the  caloric  requirements  for  a  forty-day 
fast — about  12  pounds  for  a  man  weighing  140  pounds;  a 
man  of  full  stature  should  not  carry  more  than  34  pounds 
of  fat. 

(d)  It  is  comparatively  easy  by  superalimentation  to  increase 
body  weight  from  one-half  to  one  pound  per  day  by  depos- 
iting fat.  Benedict  believes  that  in  the  entire  absence  of 
food,  even  on  exposure  to  cold  or  at  strenuous  muscular 
exertion,  the  body  cannot  utilize  more  than  one-half  pound 
of  fat  daily,  and,  while  greater  loss  may  occur  in  sickness, 
the  physiological  reduction  of  weight  on  a  low  diet  will 
equal  the  rate  at  which  fat  can  be  deposited. 

WASTE  AND  DIGESTIBILITY  OF  FOODSTUFFS 

Benedict,  who  has  studied  this  subject  from  every  viewpoint,  holds 
that  the  waste  of  foodstuffs  occurs  both  economically  and  physiologically. 
First,  the  loss  in  transportation  to  the  retail  market;  second,  the  loss  in 
preparing  and  serving,  besides  the  financial  loss  in  using,  often  through 
ignorance,  expensive  nutrients  of  a  lower  protein  or  caloric  value  than 
cheaper  foods.  Again  in  the  trimming  and  paring  of  foods,  the  cook 
often  wastes  large  quantities  and  finally  at  the  table  the  waste  is  consid- 
erable, when  the  serving  is  larger  than  is  eaten,  and  must  be  borne  in 
mind  in  all  cases  when  computing  nutrients  from  a  caloric  viewpoint. 

In  the  average  well-to-do  American  family,  the  percentage  of  waste 


104    FACTORS   IN   DIET,   DIGESTION   AND   ASSIMILATION 

of  digestible  and  assimilable  foods  in  the  kitchen  and  at  the  dining 
table  ranges  from  10  to  50  per  cent.  Gross  waste  is  often  due  to  igno- 
rance on  the  part  of  the  cook  and  other  servants.  On  the  other  hand,  the 
removal  of  fat,  skin,  seed  pods,  husks,  cores  and  other  indigestible  por- 
tions of  food  material  cannot  be  considered  as  waste,  but  both  economically 
and  physiologically  the  theoretic  high  food-value  of  fat  meats  must  be 
discounted,  because  of  the  ultimate  rejection  of  fat. 

Physiologically,  food  waste  can  be  accounted  for,  first,  by  the  ex- 
cessive ingestion  of  one  or  more  kinds  of  organic  nutrimenls,  and,  second, 
by  the  swallowing  of  foods  which  have  been  imperfectly  comminuted. 
Vegetable  foods  swallowed  whole,  such  as  beans,  peas,  corn,  huckleberries, 
etc.,  largely  escape  digestion,  because  their  skins  or  husks,  composed 
largely  of  cellulose  matter,  are  not  broken  up.  Likewise  starchy  vegetables, 
meats,  eggs,  etc.,  swallowed  without  proper  mastication  are  wasted  to  a 
large  degree.  When  milk  is  gulped  down  like  water,  it  forms  large  curds, 
much  of  Avhich  is  passed  away  unchanged.  Alimentary  saprojihytosis 
is  a  possible  aid  in  the  digestion  of  certain  food  materials — esijecially 
vegetable  foods  containing  cellulose  material.  The  efficiency  of  the  vari- 
ous enzymes  and  hormones  exerts  an  obvious  influence  on  the  amount  of 
alimentary  waste;  even  when  mastication  is  well  performed  and  intestinal 
saprophytosis  is  within  normal  limits,  there  is  considerable  loss  of  food 
material.  Atkinson  calculates  the  utilization  of  some  of  the  staple  foods 
as  follows : 

THE  UTILIZATION  OF  SOME  OF  THE  STAPLE  FOODSTUFFS 

Meat  and  fish,  .nearly  100%  of  protein,  79-92%  of  fat 

Eggs «      100%  "  «  96%  "    « 

Milk 88-100%  "  "  93-98%  «    "  doubtful  of  carbohydrate 

Butter '.  98%  «    « 

Oleomargarine.  96%  "    " 

Wheat  bread. .  .  81-100%  "  "  (too  little  fat  to  estimate)  99%  carbohydrate 

Com  meal 89%  «  «  «       «      «    «         «.       97^            « 

Rice 84%  «  "  «       «      «    «         «        gg^            « 

Peas 86%  «  «  «       «      «    «         «        96^            « 

Potatoes.......  74%  «  «  «       «      «    «         «        92^            « 

Beets 72%  «  «  «       «      «    «         «        82^            « 

The  experiments  of  Leo  Breisacher  call  attention  to  the  loss  of  albu- 
min, as  ranging  from  2.0  per  cent  to  4.9  per  cent  on  a  milk  and  cher-se 
diet,  and  n..5  per  cent,  7  to  7.1  per  cent  on  milk  alone.  For  loss  on  other 
diets  consult  the  following  tables  from  Breisacher,  referred  to  by  Benedict : 


WASTE    AXl)    13IGESTIBIJJTY    OF    FOOJ)STUFFS      105 

Pekcentage  oe  Unabsokbed  Albumin  (Breisacher) 

Corn  meal 15.5%      Peas  and  bread ....  12.2%      Wheat  bread 19.9% 

Rice 20.4%      Rye  bread 22.2%      Wheat  bread 18.7% 

Peas,  cooked  soft.  .  .17.5%      Black  bread 32.  %       Potatoes 32.2% 

Peas,  cooked 27.8%      Lentils 40.  %      Potatoes,  lentils  and 

bread 53.5% 

Percentage  of  Unabsorbed  Fat   (Breisacher) 

Olive  oil  (liquid  at  ordinary  temperatures) . .  .  .2.3% 

Butter   (melting  point  31°  C) 1.28-6% 

Lard  «  «     34°  C 2.5% 

Tallow  "  "     49°  C 7.4% 

Stearin  "  «     60°  C 86-91%  unabsorbed 

The  excretion  of  fat  in  the  stools  varies  with  the  conditions  under 
which  it  is  ingested.  During  fasting  there  is  a  daily  loss  in  the  stools 
of  somewhat  more  than  one  gram  of  fat.  When  the  quantity  ingested 
is  from  25  to  40  grams,  the  loss  varies  from  10  to  15  per  cent,  i.e.,  about 
4  grams.  When  the  quantity  ingested  is  increased  to  100  grams,  the 
gi-oss  loss  remains  practically  the  same.  The  reduction  in  percentage 
may  reach  a  point  as  low  as  1.25  per  cent.  The  explanation  of  this 
discrepancy  is  found  in  the  fact  that  when  very  little  fat  is  eaten,  it 
consists  chiefly  of  beef,  mutton  or  other  meat  fat,  and  of  vegetable  fat 
which  is  embedded  in  the  cellulose.  The  loss  of  fat  when  small  quanti- 
ties are  taken  averages  about  the  same  as  the  loss  during  fasting,  about 
1  gram  daily.  When  the  daily  quantity  of  fat  exceeds  150  grams,  the 
loss  increases  in  proportion  and  may  reach  20  per  cent.  This  high  rate 
of  loss  is  most  apt  to  occur  when  oils  having  a  direct  laxative  action  are 
administered.  With  a  coarse  vegetable  diet,  the  loss  of  all  nutrients 
increases  progressively.  This  effect  is  partly  due  to  the  laxative  action 
of  the  so-called  coarse  vegetables. 

From  these  data  it  appears  that  the  finer  the  subdivision  of  the  food 
inge.'^ted,  the  larger  will  be  the  proportion  of  nutrients  assimilated. 
For  example,  in  the  case  of  bread  made  from  decorticated  whole  wheat 
meal,  about  00  per  cent  of  its  protein  and  02  per  cent  of  its  carbohydrates 
arc  utilized,  while  fine  white  bread  made  from  bolted  flour  yields  81  per 
cent  of  its  protein  and  nearly  100  per  cent  of  its  carbohydrates.  Pota- 
toes offer  another  interesting  example:  As  ordinarily  cooked  and  masti- 
cated, this  vegetable  yields  about  YO  per  cent  of  its  protein  and  92  per 
cent  of  its  carbohydrates  to  nearly  100  per  cent.  The  class  of  coarse 
vegetables,  including  turnips,  carrots,  beets  and  cabbage  after  thorough 
cooking  yield  protein  in  the  proportion  of  from  60  to  80  per  cent,  and 


106    FACTORS   IN   DIET,   DIGESTION  AND   ASSIMILATION 

from  80  to  85  per  cent  of  carbohydrates.  On  the  other  hand,  if  these 
vegetables  are  not  thoroughly  cooked  and  well  masticated,  and  if  in 
addition  they  are  habitually  used  and  in  generous  quantities,  their  excre- 
tion may  ultimately  exceed  their  utilization. 

It  has  been  estimated  by  Rubner  that  on  an  ordinary  mixed  diet  the 
nutrient  waste  amounts  to  about  8  per  cent  of  the  total  calories,  and  we 
may  safely  conclude,  therefore,  that  from  200  to  300  calories  of  the 
standard  ration  may  be  considered  as  a  physiological  waste — by  failure 
of  digestion.  This  waste  is  taken  into  consideration  when  estimating  the 
required  calories  which  are  stated  in  terms  of  ingested  food.  Therefore 
this  variation  is  not  of  importance,  and  the  physiological  waste  of  nutrients 
need  not  be  given  any  consideration.  Variations  in  food  waste  may 
possibly  explain  the  fact  that,  say,  two  persons  of  the  same  weight  and 
following  the  same  vocation  may  require  different  amounts  of  food  to 
maintain  normal  weight  and  health.  The  fecal  excretion  from  a  normal 
person  averages  from  100  grams  per  day  moist  weight  upward,  and  on 
analysis  will  be  found  to  contain  20  per  cent  of  fat  and  7  per  cent  of 
albumin,  estimated  by  multiplying  the  nitrogen  by  6.25.  In  wasting 
diseases,  it  is  considered  practical  to  try  to  determine  the  amount  of  waste 
of  nutrients  in  the  alimentary  canal,  but  the  difficulty  and  expense  usu- 
ally prevent  such  determinations.  Still  something  may  be  accomplished 
by  ordinary  chemical  tests  and  by  macroscopic  and  microscopic  exami- 
nation within  the  abilities  of  the  clinician. 

Contrary  to  popular  belief,  it  is  quite  difficult  to  give  an  intelligent 
opinion  concerning  a  general  comparison  of  foodstuffs  as  regards  their 
digestibility.  A  few  inorganic  ingredients  of  the  diet — such  as  water 
and  salines — require  no  digestion.  Benedict,  who  has  studied  this  sub- 
ject very  carefully  and  exhaustively,  holds  that  we  have  no  precise  en- 
lightenment concerning  the  relative  digestibility  of  hemoglobin,  nucleins, 
lecithin,  organic  combinations  of  iodin  as  in  the  thyroid.  Carbohydrates 
and  proteins  undergo  many  changes  before  final  absorption.  For  instance, 
cooked  starch  is  partially  digested,  both  mechanically  and  chemically ; 
dextrin,  as  in  bread  crust,  is  still  further  digested ;  the  double  hexoses, 
as  cane  sugar,  maltose — a  stage  of  digestion  beyond  colorless  dextrin — 
and  lactose  require  inversion  into  single  hexoses,  and  of  the  latter  dex- 
trose is  the  ultimate  one  ready  for  oxidation,  while  levulose  and  galactose 
must  be  changed  into  dextrose.  The  hydrocarbons  split  into  glycerol  and 
fatty  acids ;  the  former,  uniting  with  water,  forms  glycerin,  and  the  latter 
joins  with  alkaline  bases  and  forms  soaps,  yet  it  does  not  appear  that 
either  glycerin  or  soaps  can  in  any  particular  be  considered  as  nutrients. 


WASTE    AND    DIGESTIBILITY    OF    FOODSTUFFS     107 

There  is  still  cousiderable  uncertainty  as  to  the  digestion  of  fats.  At- 
water  estimates  that  95  per  cent  of  fat  of  all  animals  is  absorbed,  and 
only  DO  per  cent  of  the  fat  of  vegetables.  Rubner  declares  that  only  80 
per  cent  of  the  fat  from  beef  and  mutton  is  absorbed.  Butter  is  fairly 
well  absorbed,  while  bacon  fat  is  not  so  well  absorbed,  because  it  is 
enclosed  in  cells,  and  from  7.5  to  17.4  per  cent  escapes  absorption.  It 
is  safe  to  assert  that  the  lower  the  melting  point  of  fat  the  greater  will 
be  the  percentage  of  absorption.  It  has  been  found  that  about  5^/2 
ounces  can  be  absorbed  without  any  loss  being  detected  on  examination 
of  the  fecal  excreta. 

It  is  held  that  the  coagulation  of  protein  is  a  preliminary  step  in  the 
process  of  digestion.  Benedict  holds  that  there  may  be  some  good 
grounds  for  the  old  theory  that  this  stage  in  protein  digestion  acts  as  a 
safeguard  against  excessive  protein  nourishment,  though  of  course  he 
realizes  that  it  is  not  a  safeguard  against  the  after-effects  of  the  end 
products  of  protein  digestion.  Rennet  coagulates  the  caseinogen  of  milk. 
The  gastric,  pancreatic  and  intestinal  juices  also  coagulate  caseinogen, 
although  the  pathologic  instances  when  the  former  fails  to  coagulate  milk 
are  nearly  always  confined  to  adults,  and  this  peculiar  factor  of  safety  is 
ndt  quite  well  understood.  There  is  yet  some  question  whether  there 
exists  a  separate  rennet  ferment  or  ferments,  or  if  coagulation  is  really 
brought  about  by  pepsin,  trypsin,  and  the  intestinal  activation  for  tryptic 
digestion.  A  certain  amount  of  coagulation  takes  place  in  the  process 
of  cooking  of  proteins  which  may  be  considered  a  step  in  digestion;  but 
the  principal  aim  in  cooking  is  to  kill  parasites,  including  various  bac- 
teria, and  at  the  same  time  to  render  the  food  more  tasty  and  more  readily 
masticated  and  comminuted.  While  artificial  coagulation  of  milk  by 
rennet  may  be  considered  a  digestive  process,  yet  it  does  not  appear  to 
aid  its  further  digestion  in  the  alimentary  canal,  and  the  curd  if  dried 
and  reduced  to  a  fine  powder  Is  more  difficult  of  digestion  than  raw  cow's 
milk.  The  digestifmof  proteins,  artificially,  has  not  yet  been  successfully 
accomplished.  The  so-called  predigested  protein  occurs  mainly  as  albu- 
mose,  and  if  the  process  is  carried  further  it  reaches  the  peptone  stage, 
making  a  disagreeable  bitter  product,  actually  toxic.  When  reduced  to 
the  amiiio-acid  stage  there  is  a  question  whether  the  nutritive  value  is  lost, 
but  this  has  recently  been  Stoutly  denied, 

Vegefahle  foods  containing  a  relatively  high  percentage  of  cellulose 
are  indigestible,  not  that  cellulose  itself  is  a  nutrient,  but  that  a  mesh- 
work  of  colliiloiie  incloses  the  starchy  granules  and  other  nutrients  which 
eseai)o  digestion,  and  in  this  way  causes  considerable  waste  of  food  ma- 


108    FACTORS   IN   DIET,   DIGESTIOX  AND   ASSIMILATION 

terial.  It  must  not  be  overlooked,  however,  that  cellulose,  especially  that 
occurring  in  fine,  threadlike  meshes,  is  stimulating  to  peristaltic  action. 
Cartilaginous  or  tendinous  fibrous  tissue  is  likewise  indigestible,  and 
when  muscular  tissue  is  not  cut,  chopped  or  comminuted  sufficiently, 
there  will  be  considerable  waste  of  nutriment.  Many  of  the  older  physi- 
ologists worked  out  elaborate  tables  to  show  the  length  of  time  required 
for  the  stomach  to  perform  its  functions.  W.  Oilman  Thompson (3) 
compiled  a  table  showing  the  time  of  the  average  sojourn  in  the  stomach 
of  various  food  products.  ]\Iodern  research  emphasizes  the  physiological 
fact  that  this  is  not  a  test  of  digestion  itself,  because  gastric  digestion  is 
not  complete,  for  the  reason  that  the  process  of  digestion  is  only  begun 
in  the  stomach.  In  other  words,  the  function  of  the  stomach  is  only  to 
make  ready  the  foodstuffs  for  the  various  processes  of  digestion. 

It  is  quite  difficult  to  arrive  at  an  accurate  estimation  of  the  digesti- 
bility of  fruits.  If  they  are  not  well  masticated  or  otherwise  comminuted 
there  is  considerable  waste.  When  thoroughly  masticated,  the  water  and 
inorganic  salts  are  ready  for  absorption,  and  the  metabolism  of  sugars 
is  a  simple  matter.  Most  fruits  contain  too  little  fat  to  be  considered 
and  there  is  some  doubt  as  to  the  actual  degree  of  assimilation  of  the 
protein.  Bananas  contain  a  liberal  quantity  of  raw  starch,  which  places 
them  in  a  class  by  themselves,  so  that  they  cannot  be  digested  to  any 
appreciable  extent  until  they  have  reached  the  duodenum  and  beyond. 

SUBSTITUTES    FOR    FOOD 

Substitutes  for  food  are  often  necessary,  especially  under  conditions 
in  which,  from  poverty  or  exposure,  sufficient  quantities  of  food  cannot  be 
obtained.  Under  such  conditions,  the  craving  of  hunger  may  be  dimin- 
ished and  actual  tissue-waste  may  be  retarded  by  the  substitution  of  cer- 
tain mild  stimulants  and  beverages.  Tea,  coffee  and  tobacco  all  possess 
moderate  actions  in  this  respect,  and  alcohol  under  such  conditions  is  both 
a  stimulant  and  a  food.  Natives  in  various  barbarous  or  semicivilized 
countries  while  performing  long  feats  of  marching,  being  often  unable  to 
obtain  sufficient  food  with  regularity,  make  use  of  a  variety  of  different 
substances  as  substitutes  for  food,  among  which  may  be  mentioned  betel- 
nut,  cola-nut,  Siberian  fungus,  the  coca  leaf  and  pepperwort,  which  are 
chewed  from  time  to  time,  and  hashish  and  opium,  which  are  both  eaten 
and  smoked.  Various  forms  of  alcoholic  fermented  drinks  are  made  use 
of.  Various  concentrated  foods  of  high  mitritive  value  Avith  small  bulk 
may  be  used  in  the  place  of  fresh  foods.     Attempts  have  been  made  from 


STARVATION    AND    INANITION  109 

time  to  time  by  the  beads  of  the  principal  armies  of  tbe  world  to  supply 
a  ration  with  concentrated  elements  for  tbe  use  of  troops  on  prolonged 
marches,  but  after  a  few  days'  subsistence  on  such  a  ration  it  has  been 
found  that  the  men  lose  weight  and  deteriorate  in  strength. 

STARVATION   AND    INANITION 

Starvation — Starvation  is  a  condition  brought  about  by  insufficient 
food  for  the  maintenance  of  the  body.  It  is  of  rare  occurrence  in  civilized 
communities.  In  such  extreme  cases,  life  may  be  maintained  up  to  a 
limit  of  about  40  days  if  there  is  no  deprivation  of  water  and  no  exposure 
to  cold.  During  prolonged  deprivation  of  food  the  tissues  become  ex- 
hausted in  inverse  order  to  their  functional  importance.  So  says  Bene- 
dict in  his  valuable  little  work,  "Golden  Rules  of  Dietetics."  The  gly- 
cogen stored  as  a  reserve  is  utilized  within  a  few  days,  though  sugar  may 
subsecpiently  be  formed  from  protein.  The  hydrocarbons  are  exhausted 
at  a  rate  varying  according  to  circumstances  and  individual  peculiari- 
ties, only  about  1  per  cent  remaining.  Wherever  there  is  interference 
with  the  oxidation  of  fat  as  in  certain  pathological  conditions,  the  patient 
dies  virtually  from  lack  of  the  ability  to  perform  the  various  metabolic 
]>rocesses,  Avhile  a  relative  excess  of  fat  remains.  The  skeleton  cartilages 
and  dense  fibers  remain  nearly  in  a  normal  condition ;  likewise  the  heart 
and  brain  during  starvation  are  almost  entirely  unimpaired,  while  the 
muscles  and  various  glands  are  atrophied  according  to  the  ability  of  the 
body  to  spare  their  function.  If  water  as  well  as  food  is  withheld,  death 
will  occur  in  from  five  to  eight  days. 

The  ])eriod  of  time  during  which  different  individuals  can  subsist 
without  food  depends  upon  : 

(a)   External  conditions  of  temperature  and  moisture. 

(/;)   The  amount  of  work  being  performed. 

(c)   The  physiological  conditions  of  the  body. 

(a)  The  length  of  time  that  an  individual  can  endure  stan^ation  is 
influenced  by  various  factors.  As  has  already  been  stated,  exposures  to 
cold  reduce  vitality  and  lessen  resistance,  so  that  under  these  conditions 
the  period  of  endurance  is  shortened.  A  moist  atmosphere  by  prevent- 
ing surface  evaporation  helps  to  prolong  the  possible  period  of  starvation. 
And  finally  the  maintenance  of  a  uniform  temperature  of  the  surround- 
ing air  also  prolongs  the  period  during  whicli  a  man  can  .abstain  from  food. 

(h)  Individuals  wlio  move  along  the  lines  of  tlie  least  resistance,  shun- 
ning every  form  of  exercise,  can  live  much  longer  without  food  than  those 


110    FACTORS   IN   DIET,   DIGESTION   AND   ASSIMILATION 

undergoing  strenuous  exercise.     In  time  of  famine,  self-forgetfulness  by 
diverting  the  mind  from  the  sufferings  of  the  body  tends  to  prolong  life. 

(c)  The  full-fed,  well-nourished  endure  long-er  intervals  of  abstinence 
from  food  than  weakened  invalids.  The  distressed  mental  condition 
attending  delirium  may  be  increased  by  lack  of  sufficient  nourishment. 
Sex  seems  to  exert  no  influence  upon  the  effects  of  starvation,  which  are 
most  keenly  felt  at  the  extremes  of  age,  by  young  children  and  aged 
persons. 

The  author,  while  serving  In  the  United  States  Marine  Hospital 
Service,  attended  four  sailors  who  had  been  shipwrecked  and  picked  up 
at  sea  and  brought  ashore.  These  men,  after  recovery,  related  that  when 
the  small  amount  of  water  and  food  which  they  fortunately  had,  gave 
out,  they  cast  lots  among  themselves  (five  in  number)  to  determine  which 
one  of  the  party  should  die  in  order  that  the  remaining  four  might  par- 
take of  his  flesh  and  blood  for  subsistence.  They  were  the  most  wretched 
and  despicable  human  beings  imaginable. 

A  pathetic  account  of  the  miseries  of  starvation  is  reported  in  the 
journal  of  Lieutenant  De  Long(4).  W.  Oilman  Thompson,  in  his  work 
on  "Practical  Dietetics,"  quoting  from  De  Long,  says :  "After  leaving  their 
sinking  vessel,  the  members  of  the  Arctic  expedition  were  exposed,  at  first 
in  open  boats  and  later  in  their  long  sledge  journey,  to  the  most  exhaust- 
ing work  and  to  intense  suffering  from  cold  and  wet.  They  frequently 
dragged  their  sleds  in  severe  storms  for  ten  or  twelve  miles  a  day,  while 
subsisting  solely  upon  half  a  pound  of  stewed  deer  meat,  with  a  little  tea 
three  times  a  day.  This  food  being  exhausted,  they  were  obliged  to  con- 
sume the  meat  of  their  last  remaining  dog,  which  they  ate  fried.  They 
subsisted  upon  this  food  exclusively  for  four  days  longer,  having  an  allow- 
ance of  but  half  a  ]X)und  a  day,  and  finally  their  last  journey  of  twenty- 
five  miles  Avas  performed  with  no  other  nourishment  than  a  few  ounces  of 
alcohol  and  an  infusion  made  from  some  old  tea  leaves.  During  this  time 
their  intense  suffering  from  hunger  was  partially  alleviated  by  chewing 
scraps  of  deer  skin,  which,  from  its  bulk  in  the  stomach,  seemed  to  afford 
slight  relief."  De  Long  quotes  from  the  physician  in  his  Arctic  expe- 
dition: "Alcohol  proves  of  great  advantage;  it  keeps  off  the  craving  for 
food,  prevents  gnawing  at  the  stomach,  and  has  kept  up  the  strength  of 
the  men  on  an  allowance  of  three  ounces  per  day. 

"The  alcohol  being  efxhausted,  they  lived  for  another  day  upon  a  tea- 
spoonful  of  olive  oil,  with  n  breakfast  composed  of  an  infusion  made  from 
the  Arctic  willow  (containing  really  no  nourishment)  and  'two  old  boots.' 
After  this  the  men,  becoming  weaker  and  weaker,  were  unable  to  proceed 


STARVATION    AND    IXAXITION  111 

farther  on  their  jouniej,  being  di-ivcii  back  by  iuteiise  cokl  and  the  dif- 
ficulty of  crossing  the  partly  frozen  rivers.  Their  feebleness  gradually 
overcame  them,  until  one  by  one  they  died  of  inanition.  Four  men  sur- 
vived for  sixteen  days  upon  absolutely  no  food  whatever,  and  possibly  their 
sufferings  were  even  further  prolonged,  but  the  journal  of  their  gallant 
and  heroic  commander  ceased  at  this  point,  for  he,  too,  died." 

Inanition — Inanition  is  the  inability  of  the  tissues  to  assimilate  food. 
The  term  should  be  restricted  to  those  cases  of  acute  starvation  observed 
in  early  life.  It  is  characterized  by  loss  of  weight  due  to  a  disordered 
metabolism.  This  condition  is  characterized  by  fever,  and  the  malady 
is  not  infrequently  mistaken  for  some  other  disease.  It  follows  the 
ingestion  of  improper  food  or  abstinence  from  food,  where  infants  are 
abandoned,  or  other  cases  that  are  grossly  neglected  and  starved.  Gross 
errors  in  feeding  are  a  contributing  cause — where  food  is  given  which  is 
absolutely  unsuited  to  the  needs  of  the  child. 

Individuals  who  are  well  supplied  with  a  reserve  of  food  stored  in 
their  tissues  can  resist  starvation  by  calling  upon  this  reserve  to  maintain 
the  energy  of  the  body  in  the  absence  of  food ;  and,  having  a  larger  supply 
than  thin  or  emaciated  persons,  they  can  withstand  starvation  for  a  much 
longer  period,  although  they  may  complain  more  bitterly  of  the  pangs  of 
hunger  than  individuals  previously  accustomed  to  a  scant  diet. 

Experiments  were  conducted  by  Chossat  to  determine  the  rapidity  of 
the  loss  of  body  weight,  etc.,  and  it  was  found  that  starving  animals, 
while  losing  40  per  cent  of  their  body  weight,  lost  in  fat  90  per  cent. 
"Anselmier  fed  starved  dogs  upon  their  own  blood  and  succeeded  in  pro- 
longing their  lives  for  three  or  four  days  beyond  the  usual  limit,  until  60 
instead  of  40  per  cent  of  their  body  weight  had  been  lost."  During  the 
winter  of  1776  and  1777  an  accident  occurred  in  a  colliery  in  South  Wales 
which  resulted  in  the  imprisonment  of  four  men  and  a  boy  for  ten  days 
without  food.  When  they  were  rescued  they  were  alive,  though  very 
feeble,  and  were  able  to  walk  when  released.  Fortunately,  a  supply  of 
water  was  available  and  the  atmosphere  in  which  they  were  confined  was 
moist.  A  second  accident  occurred  in  this  colliery  and  a  number  of  men 
were  confined  in  a  mine  for  six  days  without  food,  and  while  their  suf- 
ferings were  extreme,  nearly  all  were  able  to  walk  on  being  rescued.  From 
this  we  may  assume  that  the  lack  of  food  may  be  endured  with  far  less 
torture  if  water  is  applied  internally  and  externally.  When  water  is  with- 
held in  such  a  condition,  the  body  loses  weight  very  rapidly,  the  tissues 
become  dry,  thirst  excessive,  the  secretions  suppressed,  and  suffering  is 
very  ereatlv  intensified. 


112    FACTOKS   IN  DIET,   DIGESTIOX  AND   ASSIMILATION 

FASTING 

Fasting  is  one  of  the  most  ancient  religious  rites  of  which  there  is  any 
record.  More  than  two  thousand  years  ago  the  fasting  cure  was  advocated 
by  the  school  of  the  natural  philosopher,  Asclepiades(5),  who  also  applied 
the  'Svater  cure."  It  is  recorded  that  Plutarch  said,  "Instead  of  using 
medicines,  rather  fast  a  day." 

Fasting  in  Religion. — It  was  practiced,  as  stated  above,  in  connection 
with  religious  ceremonies  and  so  came  to  be  considered  an  inseparable  part 
of  almost  all  such  observances.  Thus  we  read  in  a  queer  old  book,  entitled 
"Of  Good  Workes,  and  First  of  Fasting" (6),  that  the  Church  of  Eng- 
land speaks  of  fasting  and  of  its  treatment  by  the  Council  of  Calderon 
as  follows: 

The  Fathers  assembled  there  .  .  .  decreed  in  that  Council  that  every  person,  as 
well  in  his  private  as  public  fast,  should  continue  all  day  without  meat  and  drink, 
till  the  evening  prayer.  And  whosoever  did  eat  and  drink  before  the  evening 
prayer  was  ended  should  be  accounted  and  reputed  not  to  consider  the  purity  of 
his  fast.  The  canon  teacheth  so  evidently  how  fasting  was  used  in  the  primitive 
Church,  as  by  words  that  cannot  be  more  plainly  expressed. 

From  the  above  quotation  we  find  that  fasting  was  considered  to  be  a 
highly  important  part  of  the  religious  ceremony,  and  of  spiritual  salva- 
tion. We  find  this  same  idea  expressed  throughout  the  Holy  Writ  in 
passages  too  numerous  to  mention (7).  The  excellent  work,  "Vitality, 
Fasting  and  Nutrition,"  by  Carrington  (Rebman  Co.),  has  been  freely 
consulted  and  quoted  in  the  preparation  of  this  section. 

We  hardly  need  to  be  reminded  that  the  Holy  Nazarenc  himself  fasted 
for  forty  days.  Many  people  accept  Christ's  forty-day  fast  as  sufficiently 
explained  by  his  supposedly  Divine  Power.  It  was,  in  short,  a  miracle 
Avhich  would  be  impossible  under  ordinary  circumstances  for  any  other 
man.  Dr.  Tanner  aroused  the  whole  scientific  world  a  few  years  ago 
by  fasting  forty  and  again  forty-two  days,  on  two  separate  occasions,  and 
while  charges  of  "fraud"  were  circulated  at  the  time  and  believed  in  by 
many,  yet  no  one  who  took  possession  of  the  facts  of  the  case  gave  any 
credence  whatever  to  these  stories.  Great  as  was  the  prejudice  in  profes- 
sional circles,  and  bitter  as  was  the  feeling  at  the  time,  no  direct  charge 
of  fraud  could  be  made,  for  no  atoms  of  proof  of  such  were  forthcoming. 
The  general  view  of  fasting  is  probably  well  summed  up  by  the  Reverend 
Puller(8)  when,  in  discussing  the  previously  mentioned  cases  of  fasting 
during  Lent  in  Jerusalem,  he  remarks : 


FASTING  113 

Such  fasting  is  certainly,  for  the  mass  of  English  people,  impossible  now.  It 
seems  to  me  that  tliis  great  difference  in  the  power  of  fasting,  which  is  quite  in- 
disputable, must  be  taken  into  account,  wiien  we  are  considering  how  to  apply  the 
Apostolic  rule  to  modern  circumstances. 

Victims  of  forced  fastiug-  and  starvation  become  so  ravenous  that  all 
sense  of  taste  gives  place  to  intense  luinger.  ]\lusciilar  action  is  no  longer 
possible.  There  is  vertigo  and  faintness  on  raising  the  head,  the  voice 
is  lost,  and  gradually  the  nervous  system  succumbs  to  languor  and  general 
prostration.  Chambers  records  an  occurrence  where  three  men  and  two 
boys  were  starved  for  twenty-two  days  in  an  open  boat.  They  had  ten 
days'  ration  to  start  with,  and  subsequently  nothing  but  old  boots  and 
jellyfish,  and  they  fought  violently  with  one  another  over  these. 

Robert  de  Moleme,  the  founder  of  the  Cistercian  brotherhood,  was  overcome 
with  grief  on  learning  of  the  death  of  a  female  friend,  and  like  General  Boulanger, 
resolved  to  follow  her  to  the  Land  of  Shades.  Being  averse  to  direct  suicide,  he 
retired  to  the  mountain  lodge  of  a  relative  friend,  and  abstained  from  food  in  the 
hope  that  one  of  his  frequent  fainting  fits  would  fade  into  the  sleep  that  knows 
no  waking.  But  finding  himself  alive  at  the  end  of  the  seventieth  day,  he  recon- 
sidered his  resolution  and  began  to  suspect  a  miraculous  interposition  of  Provi- 
dence. By  resuming  his  meals,  in  half  ounce  installments,  he  contrived  to  recover 
from  the  condition  of  frightful  emaciation,  and  in  the  supervision  of  an  ever-in- 
creasing number  of  scattered  monasteries,  led  an  active  life  for  the  next  fourteen 
years (9). 

No-Breakfast  Plan. — The  American  apostle  of  ''fasting  as  cure  for  dis- 
ease" was  the  late  Dr.  Dewey (10),  who  recommended  fasting  as  a  relief 
for  certain  disorders.  That  short  fasts  are  beneficial  to  many  people  there 
can  be  no  question.  Such  fasts  have  been  practiced  from  time  immemorial. 
1  )ewey  was  the  first  to  urge  the  "no-breakfast"  plan  of  restricting  the 
intake  of  food,  on  the  supposition  that  the  majority  of  people  coustimed 
a  great  deal  more  food  than  was  required. 

This  apostle  says(ll)  :  "There  is  no  necessity,  after  a  night  of  undis- 
turbed restful  sleep,  to  partake  of  food ;  sleep  is  not  a  hunger-causing 
process."  He  deprecates  the  American  breakfast,  holding  that  when  "we 
arise  in  the  morning  with  our  brains  recharged  by  sleep,  we  should  at 
once  go  to  our  place  of  business."  He  also  says  it  is  "a  foolish  expendi- 
ture of  energy  to  take  any  kind  of  physical  exercise  in  the  early  morning," 
holding  to  the  view  that  when  one  has  worked  long  enough  he  will  be- 
come fatigued,  and  when  this  point  is  readied,  li(>  should  have  a  ])eriod  of 
rest  preceding  the  partaking  of  food. 


114  FACTOES  m  DIET,  digestio:n^  axd  assimilatio:n^ 

We  cannot  waste  space  in  replying  to  his  assertions.  We  agree,  how- 
ever, that  moderate  fasts  are  beneficial,  but  should  not  be  instituted  except 
under  the  personal  observation  of  the  family  physician.  Dewey's  no- 
breakfast  plan  is  not  an  ideal  institution  for  general  application.  It 
might  be  suited  to  the  Eskimo,  who  consumes  enormous  quantities  of  meat 
and  oil  at  one  sitting,  or  for  the  city  dweller,  who  keeps  late  hours  and 
partakes  of  midnight  suppers,  who  is  a  spender  and  not  a  producer,  but 
for  the  business  man,  a  light  repast  to  break  the  fast  is  necessary. 

The  Frenchman,  as  a  rule,  with  the  exception  of  his  roll  and  cup  of 
chocolate  in  the  morning,  partakes  of  but  little  food  until  midday.  The 
Englishman  consumes  a  rather  hearty  breakfast  at  an  early  morning  hour, 
which  the  average  American  and  Canadian  consider  meager.  The  two 
latter  want  meat,  cereals,  fruits  and  coffee.  It  is  not  disputed  but  that 
many  people  would  be  in  better  health  if  they  had  no  breakfast  at  all, 
but,  generally  speaking,  most  Americans  eat  too  much  at  all  three 
meals. 

An  ideal  breakfast  for  those  following  sedentary  occupations  is  a  fruit, 
a  cereal,  an  egg  or  a  piece  of  breakfast  strip,  a  roll  and  a  small  cup  of 
coffee.  As  said  before,  we  are  opposed  to  the  no-breakfast  plan,  believing 
that  the  body  has  need  for  material  to  produce  heat  and  energy,  and  ab- 
stinence from  food  until  the  middle  of  the  day  tends  to  draw  too  heavily 
upon  the  reserve  store  of  protein  and  glycogen,  and  possibly  to  a  limited 
extent  upon  the  store  of  fat.  Tlie  no-breakfast  plan  would  not  satisfy  the 
wants  and  needs  of  the  majority  of  live  active  individuals  who  lead  strenu- 
ous lives,  and  again  the  no-breakfast  eater  is  usually  a  complaining, 
scrawny,  puny  individual  as  compared  with  the  hearty  breakfast  eater. 

Fasting  as  a  Cure — It  is  claimed  by  devotees  of  fasting  as  a  cure  that 
the  principle  on  Avhich  the  hunger  cure  acts  is  one  with  which  all  physiol- 
ogists are  acquainted.  During  a  fasting  condition,  nature  makes  an  effort 
to  rid  the  body  of  effete  material.  This  the  author  experienced  in  a  ten- 
day  fast  a  few  years  ago.  He  was  suffering  from  intestinal  stasis  with 
putrefaction  of  the  alimentary  contents.  The  end  products  of  protein 
digestion  were  greatly  disturbing  the  metabolic  processes  of  the  body,  re- 
sulting in  both  mental  and  physical  hebetude.  At  the  suggestion  of  a 
medical  confrere,  the  author  went  on  a  ten-day  fast  with  no  aliment  ex- 
cept strained  vegetable  soup  made  without  meat  or  fats.  The  craving 
for  food  was  very  strong  for  the  first  two  or  three  days,  but  after  this, 
going  without  the  ternary  food  elements  caused  very  little,  if  any,  incon- 
venience or  annoyance,  except  for  the  elimination  of  most  offensive  ex- 
creta, which  was  aided  by  the  self-administration  of  Kussian  mineral  oil. 


FASTING  119 

When  he  returned  to  his  former  dietary  habits,  which  were  slowly  and 
carefully  resumed,  there  was  noticeable  improvement  in  his  condition. 

Temporary  denutrition  exercises  a  favorable  influence  in  certain  dis- 
orders, more  particularly  of  the  alimentary  tract,  such  as  intestinal  auto- 
intoxication, intestinal  stasis  with  putrefaction,  intestinal  toxemia,  etc. 
It  gives  nature  a  chance  to  clean  house.  The  organism,  on  a  starvation 
dietary,  soon  begins  to  lessen  the  outgo  of  energy.  The  movements  of  the 
organs  of  respiration  slow  down,  the  temperature  drops  slightly  below 
normal,  the  secretion  of  bile  and  uric  acid  is  lessened,  and  later  it  is 
claimed  that  there  is  retrenchment  of  the  assimilative  functions,  reacting 
on  the  intestinal  organs,  the  colon  contracting,  while  the  "small  intestine 
retains  all  but  the  most  irritating  ingesta." 

Beyond  question,  by  temporarily  depriving  the  body  of  the  supply  of 
food  it  has  been  continually  ingesting  in  excess  of  actual  needs,  we  give 
the  organs  of  elimination  a  chance  to  clean  the  polluted  sewers,  and  to  un- 
load the  superfluous  impurities  by  the  various  eliminative  organs,  which 
exerts  a  beneficial  effect  to  tlie  whole  organism. 

Long-continued  Undernutrition. — Man,  after  all,  is  more  or  less  a 
creature  of  habit,  and  really  the  whole  question  of  the  amount  of  food  daily 
ingested  is  essentially  one  of  habit.     As  Chittenden (12)  has  aptly  said: 

The  so-called  cravings  of  appetite  are  purely  the  result  of  habit.  A  habit,  once 
acquired  and  persistently  followed,  soon  has  us  in  its  grasp,  and  then  any  devia- 
tion therefrom  disturbs  our  physiological  equilibrium.  The  system  makes  com- 
plaint and  we  experience  a  craving,  it  may  be,  for  that  to  which  the  body  has 
become  accustomed,  even  though  this  something  be,  in  the  long  run,  distinctly  in- 
jurious to  the  welfare  of  the  body.  There  has  thus  come  about  a  sentiment  that 
the  cravings  of  the  appetite  for  food  are  to  be  fully  satisfied,  and  this  is  merely 
obedience  to  Nature's  laws.  The  idea,  however,  is  fundamentally  wrong.  Anyone 
with  a  little  persistence  can  change  his  or  her  habits  of  life,  change  the  whole 
order  of  cravings,  thus  demonstrating  that  the  latter  are  purely  artificial,  and  that 
they  have  no  necessary  connection  with  the  welfare  or  needs  of  the  body.  In  other 
words,  dietetic  requirements  are  to  be  founded,  not  upon  so-called  instinct  and 
craving,  but  upon  reason  and  intelligence. 

After  all,  undernutrition  can  only  be  followed  by  disastrous  results 
if  long  continued.  Many  are  tlie  human  derelicts  stranded  on  the  rocks 
of  semistarvation,  "especially  of  protein  starvation,  the  result  /)f  having 
been  compelled  to  subsist,  as  many  poor  but  respectable  ]x^ople  have  been, 
for  a  prolonged  period  upon  'bread  and  tea'  because  of  the  deficiency  of 
protein  in  these  foods.  Doficieucy  of  protein  loads  to  wasting  and  degen- 
eration of  all  muscular  and  neiTous  tissues;  and,  even  when  it  is  barely 


116    FACTORS   I?T  DIET,   DTGESTIOJ^  AND   ASSIMILATION 

sufficient,  the  individual  does  not  always  ultimately  recover,  but  is  prone 
to  remain  neurotic  and  subject  to  many  ailments." 

Fasting  Experiments — Fasting,  of  late  years,  has  been  attempted  either 
by  love  of  notoriety  or  desire  for  pecuniary  gain  by  persons  exhibiting 
themselves  for  gratification  of  public  curiosity.  They  are  generally  frauds 
and  are  fed  by  some  one  in  collusion  with  them.  In  a  number  of  cases, 
the  subjects  have  been  carefully  studied  by  medical  experts,  and  there  is 
no  question  that  in  some  instances,  at  least,  the  fasts  have  been  conducted 
with  honesty.  Thompson (3)  reports  two  authenticated  fasts  where 
Tanner  and  Succi  were  the  subjects.  A  period  of  starvation  was  prolonged 
for  40  days  and  over.  In  both  instances  fluids  were  allowed,  and  in  one 
of  the  men  intense  epigastric  pain  and  food  craving  was  ameliorated  by 
medication. 

"Succi,  an  Italian  subject,  in  1890,  undertook  an  absolute  fast  of  40 
days,  during  which  time  he  lost  421/2  pounds  and  drank  an  average  of 
25i/>  ounces  of  water  daily.  The  water  he  consumed  was  in  the  form  of 
plain  water,  mineral  water  and  ice.  He  lost  flesh  very  rapidly  during  the 
fast,  but  on  the  last  day  he  had  strength  sufficient  to  walk  around  the  room. 
When  he  resumed  eating  he  first  took  cocoa  and  subsequently  bouillon 
and  otlier  light  liquid  diet,  gradually  returning  to  solid  food.  His  mental 
faculties  were  unimpaired  throughout.  He  occasionally  took  small  doses 
of  a  few  drops  of  an  elixir  supposed  to  contain  opium." 

Lnigi  Cornaro,  a  Venetian  gentleman,  published  a  treatise  on  a  "Tem- 
perate Life,"  advocating  a  very  abstemious  diet.    He  says : 

I  do  not  know  whether  some  desperate  degrees  of  abstinence  would  not  have 
the  same  effect  upon  other  men,  as  they  had  upon  Atticus  who,  weary  of  his  life  as 
well  as  liis  physicians,  by  long  and  cruel  pains  of  a  dropsical  gout,  and  despairing 
of  any  cure,  resolved  by  degrees  to  starve  himself  to  death,  and  went  so  far,  that 
the  physicians  found  he  had  ended  his  disease  instead  of  his  life! 

His  case  is  often  referred  to  as  an  illustration  of  the  smallest  quan- 
tity of  food  which  will  support  life.  In  his  early  days  he  was  a  reckless, 
intemperate  youth,  and  spent  his  time  "in  riotous  living."  Later  he  re- 
formed and  by  careful  dieting  prolonged  his  life  to  103  years.  During 
the  last  48  years  of  his  existence,  he  subsisted  largely  on  an  allowance  of 
twelve  oynces  of  vegetable  food  and  14  ounces  of  wine.  Occasionally,  he 
partook  of  eggs,  but  rarely  took  any  other  form  of  animal  food.  While 
there  may  be  much  wisdom  in  his  doctrines  as  published,  unfortunately 
no  one  who  has  attempted  to  put  his  teachings  into  practice  has  been 
similarly  rewarded  with  a  long  life.     The  majority  of  mankind  would, 


FASTING  117 

for  the  pleasures  of  the  palate,  prefer  to  live  fewer  years  in  lieu  of  the 
pleasure  of  being  less  abstemious. 

Periods  of  voluntary  fasting  of  varying  duration  are  practiced  by 
devotees  of  religious  sects.  This  practice  was  formerly  indulged  in  to 
a  greater  extent  by  ascetics  than  at  the  present  time.  Such  practices,  un- 
less they  be  definitely  limited  and  supervised,  may  be  carried  to  an  ex- 
cessive or  even  injurious  degree.  When  a  man  by  fasting  reduces  him- 
self to  the  extent  that  his  intellectual  faculties  are  obtimded,  he  may  be 
sine  that  he  is  doing  himself  injury.  It  would  be  far  better  for  such 
individuals,  for  purposes  of  mental  discipline  or  religions  motives,  to 
eliminate  temporarily  from  the  diet  accustomed  luxuries,  or  give  up  snch 
articles  in  the  daily  ration  as  butter,  sugar,  salt,  wine,  tobacco,  etc.  This, 
in  fact,  is  a  custom  practiced  by  many  persons  during  the  season  of  Lent. 
Contrary  to  the  opinion  once  held  by  the  laity,  fasting  cannot  be  regarded 
as  favoring  either  clearness  of  intellect,  muscular  strength  or  endurance. 
Gerland  emphasizes  the  folly  of  such  practices,  "the  ethnologist  can  trace 
the  physical  and  mental  decay  of  whole  nations  to  a  long  course  of  insuf- 
ficient food." 

Dr.  William  Stark,  a  young  English  physician,  lived  for  forty-four 
days  on  bread  and  water,  for  a  month  on  bread,  water  and  sugar,  and  for 
three  wrecks  on  bread,  water  and  olive  oil.  At  the  end  of  his  experiments 
he  was  in  a  very  enfeebled  state  of  health ;  he  developed  symptoms  resem- 
bling scurvy,  and  ultimately  died,  apparently  a  victim  of  his  own  scien- 
tific enthusiasm  (13). 

Effect  of  Fasting  on  Metabolism — A  knowledge  of  the  metabolic  changes 
occurring  dnring  a  fast  is  of  great  importance  both  physiologically  and 
pathologically.  Many  important  physiologic  discoveries  were  made  pos- 
sible by  experiments  on  fasting  animals  and  men,  while  pathology  has 
benefited  by  examinations  of  diseased  persons  who  were  starving  or  nearly 
starving. 

The  effects  of  fasting  on  metabolism  have  been  studied  at  length  by 
Benedict(14).  He  carried  out  an  experiment  on  a  man  during  a  seven 
days'  fast.  He  found  the  loss  was  estimated  to  be:  protein  69.5.  fat  139.6, 
glycogen  23  grams  per  day,  yielding  1,597  calories.  The  loss  of  protein 
equaled  347  grams  of  flesh;  the  actual  loss  of  energy  measured  by  the 
calorimeter  was  1,696  calories  per  day  or  100  grams  more.  The  heat  of 
conibnsHon  can  be  calculated  from  the  known  heat  value  of  the  sub- 
stances, 1  gram  of  body  protein  yielding  5.65  calories,  and  1  gram  of 
fat  9..54  calories,  and  the  total  when  fully  oxidized  would  aggregate  about 
1,734,  so  that  dnring  a  fast  the  organism  lives  on  its  own  flesh  and  fat. 


118    FACTORS   IN   DIET,   DIGESTION  AND   ASSIMILATION 

The  changes  in  the  metabolism  produced  by  sickness  cannot  be  accu- 
rately determined  without  a  knowledge  of  the  changes  due  to  simple  inani- 
tion. The  knowledge  of  the  pathology  of  the  metabolism  of  fasting  is 
sensibly  incomplete,  though  many  additions  have  been  made  to  it  during 
the  past  few  years. 

During  the  first  few  days  of  a  fast,  a  man  lives  upon  body  glycogen, 
then  upon  his  own  protein  and  fat.  In  consequence,  his  respiratory  quo- 
tient falls,  which  indicates  the  combustion  of  carbohydrates — to  approach 
the  values  indicating  the  consumption  of  protein  or  fat.  The  more  abun- 
dantly a  man  is  fed  preceding  his  fast,  the  greater  will  be  his  reserve  sup- 
ply of  glycogen  when  the  fast  begins,  and  as  a  result,  the  more  slowly 
will  his  respiratory  quotient  diminish.  This  explains  the  difference,  dur- 
ing the  first  few  days  of  fasting,  between  the  well-fed  men  observed  by 
Breithaupt  and  the  underfed  observed  by  Cetti  (15). 


FASTING  METABOLIC 

EXPERIMENTS 

Cetti 

Breithaupt 

Days 

Per  Kg.  per  Minute 

Per  Kg.  per  Minute 

of 

Fast 

O2 

CO2 

Respiratory 
Quotient 

O2 

CO2 

Respiratory 
Quotient 

1 

4.86 

3.51 

0.72 

3.96 

3.48 

0.78 

2 

4.59 

3.13 

0.68 

4.32 

3.19 

0.74 

3 

4.48 

3.07 

0.68 

4.26 

3.12 

0.73 

4 

4.78 

3.10 

0.65 

4.38 

3.19 

0.73 

5 

4.68 

3.10 

0.66 

4.37 

2.75 

0.63 

6 

4.67 

3.13 

0.67 

4.35 

2.26 

0.86 

7 

5.06 

3.39 

0.67 

3.76 

2.60 

0.69 

8 

4.89 

3.33 

0.68 

4.07 

2.94 

0.72 

9 

4.62 

3.10 

0.67 

10 

4.67 

3.16 

0.68 

Von  Noorden,  in  commenting  on  the  results  tabulated  in  the  above 
table,  says: 

The  fact  that  the  respiratory  quotient  at  times  fell  below  the  theoretical  mini- 
mum is  explained  by  the  conclusion  that  during  repose  and  abstinence  from  all 
voluntary  movements,  small  quantities  of  glycogen  arising  from  the  decomposition 
of  protein  collect  in  the  liver  and  muscles. 


If  this  is  so,  muscular  work,  which  decreases  the  decomposition  of 
glycogen,  must  also  increase  the  respiratory  quotient. 

It  is  of  great  practical  imix>rtance  to  know  whether  the  physiological 


PERVERSIONS    OF    APPETITE  119 

laws  of  prolonged  fasting  hold  good  in  chronic  malnutrition.  An  indi- 
vidual in  a  condition  of  nndcrnntrition  throngh  insnfficient  feeding  might, 
under  favorable  circumstances,  indulge  in  extravagant  metabolism,  as  he 
does  in  acute  fasting.  ''Again,  he  might  establish  a  sort  of  automatic  and 
purposive  regulation,  diminishing  the  amount  of  his  metabolism  when 
I)laced  on  a  continuously  inadequate  diet."  This  brings  up  the  interesting 
(|iie.sti()n,  ''What  amount  of  food  is  necessary  to  maintain  patients  who 
are  markedly  emaciated  from  prolonged  fasting." 

A  case  much  quoted,  recorded  by  Klemperer,  emphasized  the  food  re- 
quired to  maintain  nitrogen  equilibrium.  "A  tailoress,  aged  22,  had  been 
iniprojierly  nourished,  and  her  weight  fell  from  50  to  36  kilograms;  for 
eleven  days  she  remained  in  nitrogen  equilibrium  at  18  calories  per  kilo- 
gram." Klemperer  concluded  that,  as  she  was  in  nitrogen  equilibrium, 
his  patient  was  also  in  heat  equilibrium,  so  that  her  diet  of  maintenance 
would  be  at  the  rate  of  18  calories  per  kilogram  of  body  weight  per  day. 
Von  Noorden  points  out  the  error  of  Klemperer's  conclusion,  with  the  sug- 
gestion that  after  protracted  malnutrition,  the  organism  can  retain  nitro- 
gen to  build  up  the  cells  demanding  protoplasm,  even  when  on  a  scanty 
nitrogen  diet.     Von  Noorden  says: 

When  a  poorly  nourished  individual  after  a  protracted  fast  is  allowed  food,  in 
an  increased  amount,  sufficient  to  overcome  the  decrease  in  bodily  heat,  an  effort 
is  at  once  made  to  retain  nitrogen  and  repair  the  loss  of  cellular  material  that  has 
occurred.  This  retention  of  nitrogen  goes  on  until  the  body  has  readjusted  itself 
to  the  new  conditions  of  nutrition.  Then  the  loss  of  nitrogen  begins  anew,  unless 
the  calories  required  have  been  adequately  supplied. 

Von  Noorden  conducted  many  experiments  to  determine  the  requisite 
calories  per  kilogram  ]ier  day,  in  order  to  nuiintain  a  ])ermanent  increase 
of  weight,  and  found  it  did  not  occur  until  an  intake  of  30  to  32  calories 
was  reached. 

PERVERSIONS   OF  APPETITE 

Parorexia. — Parorexia  (16),  or  perversion  of  appetite,  is  manifested 
for  special  or  peculiar  kinds  of  fat.    There  are  three  types: 

(a)  Malacia,  a  desire  for  highly  spiced  foods,  such  as  mustard,  vine- 
gar or  green  fruits,  etc. 

(h)  Pica,  an  inexorable  desire  for  substances  which  are  not  foods, 
such  as  earth,  chalk,  pencils,  ashes,  sand  and  insects,  etc. 

(c)  Allotriophagia,  an  insatiable  craving  for  disgusting  and  hnrniful 
substances,  such  as  fecal  nuitter,  pins,  etc. 


120    FACTOKS  IJS^  DIET,   DIGESTION  AND   ASSIMILATION 

Malacia  is  often  observed  in  cases  of  disturbances  of  the  stomach  and 
neurasthenia,  while  the  other  types  are  found  chiefly  in  idiots,  lunatics 
or  in  severe  hysteria. 

Anorexia — Anorexia  is  loss  of  appetite,  practically  amounting  to  dis- 
gust for  food,  and  is  a  precursor  of  acute  gastric  or  intestinal  disorders. 
In  prolonged  fevers  such  as  typhoid,  and  some  types  of  malarial  infection, 
it  may  become  necessary  to  force  the  appetite.  In  some  instances  the 
patient  will  feel  a  loathing  for  foods,  or  there  may  be  absolute  nausea ;  at 
other  times  the  patient  may  have  a  feeling  that  he  simply  cannot  eat,  but 
the  thought  or  sight  of  food  is  not  repulsive ;  again,  the  patient  may  have 
a  slight  desire  for  food,  but  from  prejudice  or  otherwise,  which  may 
amount  to  a  delusion,  he  feels  that  food  would  add  to  his  distress. 

There  is  great  diversity  of  differences  in  the  appetite  of  individuals 
and  even  in  the  same  individual  at  different  times.  Repression  of  de- 
sires for  food,  excessive  self-control  and  habitual  abstemiousness,  prac- 
tically amounting  to  obsessions,  obtund  the  enjoyment  of  food.  Whether 
due  to  actual  lack  of  food,  poverty,  preoccupation  or  what  not,  the  tonicity 
of  the  organs  of  digestion  as  well  as  of  the  musculature  is  seriously  inter- 
fered with  by  prolonged  insufficiency  of  diet.  Nervous  anorexia  is  a 
diminution  of  appetite,  with  absence  of  the  hunger  sense,  so  that  even 
antipathy  to  food  may  be  present.  This  condition  is  present  in  most  of 
the  organic  as  Avell  as  in  the  functional  disorders  of  the  stomach,  but  the 
nervous  type  appears  as  a  primary  affection,  and  has  been  attributed  to  a 
depressed  condition  of  the  hunger  center,  or  to  hyperesthesia  of  the  mu- 
cous membrane  of  the  stomach. 

Bulimia — Bulimia,  or  hyperorexia,  is  the  habit  of  moderate  over- 
eating by  comparatively  healthy  individuals,  and  may  be  due  in  some 
instances  to  an  erroneous  conception  of  the  actual  amount  of  food  neces- 
sary to  maintain  life.  Tliere  seems  to  exist  a  popular  impression  that 
the  standard  of  strength  may  be  heightened  or  a  reserve  of  vital  force 
established  by  superalimentation. 

Certain  diseased  conditions,  as  intestinal  parasites  (not  that  the  worms 
consume  any  notable  quantity  of  nutrients),  states  in  which  the  food 
passes  rapidly  from  the  stomach,  certain  forms  of  epilepsy  and  general 
paresis,  sudden  transition  from  the  lap  of  luxury  to  poverty,  may  cause 
bulimia  of  a  severe  type.  At  times  bulimia  may  be  purely  a  matter  of 
indulgence  of  the  grosser  appetites.  For  example,  Benedict (14)  reports 
the  case  of  a  young  woman,  otherwise  dainty  and  refined,  who  would  de- 
liberately excuse  herself  from  the  table,  induce  vomiting  by  running  her 
finger  down  her  throat,  empty  her  stomach  and  return  to  the  table  to  eat 


PERVERSIONS    OF    APPETITE  121 

another  hearty  meal.  This  method  was  frequently  practiced  by  the  Romans 
dnring  their  Liieiilhin  banquets. 

Polyphagia — Polyphagia  is  the  demand  for  large  quantities  of  food 
before  satiation  occurs.  J'he  cases  do  not  feel  satisfied  until  the  food  is 
digested.  It  often  occurs  as  a  primary  condition  in  neurotics,  or  secon- 
(Inry  to  disease  of  the  gall  bladder,  spleen,  diabetes  or  brain  tumor. 
]vemp(lC)  records  a  case  that  consumed  100  pounds  of  meat  in  24 
hours. 

Akoria. — Akoria  is  the  absence  of  satiety.  Individuals  with  akoria 
never  feel  that  they  are  fully  fed.  In  fact,  they  never  know  wlien  to  stop 
eating.  Sometimes  this  condition  is  combined  with  polyphagia,  and  is 
most  often  met  with  in  neurasthenics  and  hysterics. 

Polydipsia. — Polydipsia,  or  excessive  thirst,  is  symptomatic  of  diabetes 
mellitus  and  insipidus.  It  may  be  due  to  diarrhea,  which  it  tends  to  main- 
tain ;  to  the  ingestion  of  large  quantities  of  salt  and  sugar,  requiring  dilu- 
tion ;  to  strenuous  exercise,  causing  loss  of  water  by  excessive  perspiration; 
and  if  occurring  very  suddenly,  it  may  indicate  hemorrhage.  Under  some 
circumstances,  it  is  due  to  habit,  especially  that  of  excessive  tippling, 
more  especially  if  the  beverages  contain  xantliin.  The  drinking  of  water 
and  milk  in  excessive  quantities  is  a  bad  habit  from  a  health  point  of 
view  and  is  often  indulged  in  through  misconceptions  of  the  hygienic 
value  of  liquid  nutriment.  This  misconceived  habit  sometimes  produces 
gastric  dilatation  in  athletes,  who  endeavor  to  encourage  strength  and 
vitality  by  gulping  large  quantities  of  milk.  Unfortunately  health 
cranks,  and  many  physicians  as  well,  freely  urge  the  drinking  of  exces- 
sive quantities  of  water,  overestimating  its  value  as  an  eliminant.  The 
excretion  of  large  amounts  of  water,  free  or  nearly  so  from  mineral  salts, 
interferes  more  or  less  with  osmotic  processes  generally  by  withdrawing 
the  salts  from  the  blood  and  tissues,  and  putting  extra  work  on  the  circu- 
latory glandular  and  renal  organs.  If  pure  water  is  used,  its  irritant  ef- 
fect on  the  gastric  mucosa  must  be  considered.  There  are  persons,  how- 
ever, especially  the  indolent  and  overworked,  middle-aged  and  elderly 
women,  who  drink  quantities  of  concentrated  tea.  This  habit  tends  to 
develop  a  distaste  for  water.  In  such  conditions,  as  will  be  seen,  all  the 
processes  of  the  elimination  and  secretion  are  interfered  with. 

Rumination. — Rumination  applies  more  particularly  to  animals  that 
chew  the  cud,  whose  stomachs  are  divided  into  four  compartments.  The 
first  or  largest  division  of  typical  ruminants  is  designated  as  the  paunch ; 
the  second,  the  reticulum  ;  the  third,  the  osmasum  psalterium  or  numvplies, 
and  the  fourth  the  abomasum  or  rennet  bag.     The  ruminants  swallow 


122    FACTORS   IN  DIET,   DIGESTION"  AND   ASSIMILATION 

herbaceous  food  unchewed  and  it  is  passed  into  the  paunch,  whence  later 
it  is  regurgitated  in  masses  and  thoroughly  masticated  and  mixed  with 
saliva  while  the  animal  rests,  after  which  it  is  again  swallowed. 

Merycism — Merjcism  is  a  peculiar  condition,  rare,  but  sometimes 
found  in  neurotics  who  have  the  power  of  regurgitating  food  from  the 
stomach.  In  some  instances  it  has  been  claimed  that  thej  are  able  to 
bring  up  any  particular  article  of  food  swallowed.  Benedict,  in  discuss- 
ing this  point,  describes  the  habit  as  a  pleasant  one,  which  seems  as  a 
rule  to  do  no  harm,  except  as  any  neurotic  indulgence,  but  doubts  the 
possibility  of  selective  regurgitation.  The  regurgitated  morsel  is  said  to 
often  retain  its  original  flavor,  without  sourness  or  bitterness,  which  would 
indicate  a  deficiency  of  acid  secretion  and  peptonization  or  possibly  some 
abnormality,  on  account  of  which  the  foodstuff  is  retained  in  the  esophagus. 

The  regurgitation  of  small  quantities  of  the  gastric  contents  occurs 
either  as  water-brash  or  otherwise  with  or  without  cardialgia — heartburn. 
This  condition  indicates  a  relative  disproportion  of  function  between  en- 
dogastric  tension  and  the  normal  tonicity  of  the  cardiac  sphincter.  The 
most  frequent  cause  of  this  condition  is  the  use  of  too  much  liquid  with  a 
meal,  or  too  hasty  swallowing,  so  that  too  much  air  is  introduced,  or  to 
fermentation  of  the  stomach  contents.  Tonicity  of  the  cardiac  sphincter 
is  largely  a  characteristic  of  the  individual.  For  this  reason,  some  per- 
sons cannot  follow  a  vocation  which  requires  stooping  over  soon  after 
mealtime  without  regurgitating  food  from  the  stomach. 

Vomiting. — Vomiting  occurs  as  a  sjTnptom  of  so  many  diseases  and 
functional  derangements  that  we  will  not  attempt  to  consider  the  whole 
subject  collectively,  but  will  refer  the  readers  to  various  text-books  on  the 
practice  of  medicine.  Vomiting,  so  far  as  it  is  related  to  dietetics,  may 
be  caused  by  (a)  excess  of  food,  (&)  food  and  drinks  improperly  combined, 
such  as  crabs  and  milk,  beer  and  champagne,  etc.,  (c)  fermenting  or 
poisonous  food,  {d)  irritating  and  indigestible  food,  including  that  which 
is  im])roperly  cooked,  (e)  food  that  is  eaten  in  too  great  haste  and  with- 
out proper  mastication. 

Vomiting  is  mainly  a  conservative  process  of  evacuating  excessive  and 
irritating  gastric  contents.  Individuals  that  do  not  vomit  readily  are 
more  disposed  than  others  to  serious  alimentary  disturbances.  Vomiting 
is  always  an  indication  of  gastric  disturbance  or  of  biliary  diseases.  In- 
testinal obstruction,  peritonitis,  pelvic  disease,  etc.,  need  not  be  considered 
here.  Food  which  is  wholesome  and  nourishing  may  cause  nausea  through 
association  or  environment.  Thompson (3)  records  an  example  of  this 
in  the  following  story :  A  party  of  early  California  settlers  while  cross- 


PERVERSIONS    OF    APPETITE  123 

ing  the  continent  were  lost  during  a  severe  winter  in  the  Sierras.  When 
nearly  dead  of  starvation  some  friendly  Indians  took  compassion  and  fed 
them  upon  a  delicious  finely  ground  meal,  which  for  some  days  was  their 
staple  article  of  diet,  and  on  which  they  rapidly  gained  strength.  Being 
at  first  unable  to  understand  the  Indians,  the  emigrants  could  not  learn 
of  what  the  meal  was  comi)osed.  When  at  length  they  found  out  that  it 
was  made  from  pounded  dried  grasshoppers  they  became  so  nauseated  that 
they  could  not  touch  the  food  again. 

Such  vomiting  luay  properly  be  termed  a  pure  psychosis  due  to  disgust. 
Erom  a  dietetic  standpoint,  this  form  is  important,  since  the  nutrition 
of  many  delicate  patients  depends  largely  upon  whether  food  is  prepared 
in  a  sanitary  and  hygienic  manner  and  daintily  served  amid  pleasant  sur- 
roundings.    (Volume  II,  Chapter  IV,  Hygiene  of  Eating.) 

Hiccough. — Hiccough  is  an  abrupt  and  involuntary  spasmodic  con- 
traction of  the  diaphragm  with  coincident  contraction  of  the  epiglottis. 
The  ordinary  cause  for  this  phenomenon  is  engendered  in  the  stomach 
by  the  too  rapid  introduction  of  alimentary  substances,  by  alcoholic  drinks, 
carbonic  acid,  as  well  as  by  certain  foods.  It  must  be  borne  in  mind,  how- 
ever, that  it  can  also  be  caused  by  a  deranged  state  of  the  nervous  centers. 
If  of  brief  duration,  it  is  usually  a  gastric  or  esophageal  reflex,  more  often 
the  latter.  Swallowing  too  rapidly,  swallowing  food  that  is  too  dry,  or 
in  boluses  too  large,  will  cause  spasmodic  esophageal  peristalsis.  Pro- 
longed singultus  is  a  psychosis  due  to  various  reflex  stimuli,  as  from 
biliary  calculi,  pelvic  disease,  etc. 

Aerophagia. — Aerophagia  is  to  be  distinguished  from  the  eructation 
of  gas  due  to  the  literal  swallowing  of  air  with  food  and  drink.  It  must 
also  be  distinguished  from  gas  produced  by  effervescence  or  fermentation, 
or  from  the  action  of  gastric  juices  upon  intestinal  carbonates  with  the 
pylorus  relaxed.  Genuine  aerophagia  is  an  exaggerated  condition  of 
hiccough  with  the  drawing  of  large  quantities  of  air  into  the  esophagus. 
It  is  more  often  a  neurotic  manifestation  of  hysteria,  and  while  it  may  be 
associated  wdth  gas  in  the  stomach  it  more  often  is  excited  by  the  causes 
of  hiccough. 

During  an  acute  aerophagic  attack,  patients  may  suffer  from  dyspnea, 
tachycardia  and  cyanosis.  These  distressing  sym])toms,  according  to 
Aaron (17),  are  instantly  relieved  by  introducing  the  stomach  tube,  which 
allows  the  air  to  escape.  The  distention  of  the  stomach  with  air  pushes 
the  apex  of  the  heart  upward  and  to  the  left.  This  pressure  on  the  ven- 
tricles rotates  the  heart  on  its  axis  and  distorts  the  great  vessels  at  its 
base.     The  distcudod  stomach  or  esophagus  may  disturb  the  heart  in  a 


124    FACTOKtS   IN  DIET,   DIGESTION  AND   ASSIMILATION 

retiex  manner  because  the  common  innervation  of  these  organs  is  through 
the  vagi.  Stimulation  of  the  vagi  causes  a  slowing  of  the  heart.  These 
factors  often  produce  cardiac  arrhythmias,  which  become  apparent  to  the 
patients  by  periods  of  dirt'erent  pulse-rate  and  irregularities,  causing  them 
considerable  worry  and  anxiety. 

It  is  of  the  utmost  importance  that  an  accurate  diagnosis  be  made, 
because  the  affection  is  easily  remedied.  The  roentgen  fluoroscope  will 
always  show  the  rise  and  fall  of  the  thyroid  cartilage.  This  is  helpful 
when  one  is  not  sure  of  his  diagnosis. 

The  examination  of  the  stomach  contents  in  all  aerophagics  shows  the 
presence  of  bile.  A  positive  reaction  for  bile,  with  eructations,  is  a  pathog- 
nomonic sign.  The  eructation  of  the  air  acts  as  a  siphon  and  frequently 
draws  the  bile  from  tlie  duodenum  backward  into  the  stomach.  The  find- 
ing of  bile  in  the  gastric  contents  is  decisive. 

In  the  treatment  of  aerophagy,  Aaron  is  in  the  habit  of  impressing  his 
patient  with  the  way  he  is  distending  his  stomach  with  air.  This  can 
easily  be  done  by  telling  him  to  belch  and,  while  this  is  going  on,  asking 
him  to  keep  his  mouth  open.  While  the  mouth  is  open  he  cannot  swallow 
air  and  the  eructations  quickly  cease.  At  this  stage  it  is  wise  to  explain 
to  the  patient  that  he  has  been  swallowing  air  instead  of  emptying  the 
stomach  of  gas.  In  order  to  keep  the  mouth  open  a  cork  may  be  placed  be- 
tween the  teeth  and  held  there.  In  this  way  the  air  is  prevented  from 
entering  the  esophagus.  Then  again,  in  order  to  keep  the  thyroid  carti- 
lage from  rising,  one  may  tie  a  ribbon  moderately  tight  around  the  neck. 
This  not  only  is  a  direct  restraint  but  also  serves  as  a  reminder  to  the 
patient.  After  all,  aerophagia  is  more  amenable  to  moral  suasion  than  to 
dietetic  treatment. 

Seasickness. — Seasickness  to  some  extent  is  produced  or  initiated  by 
dietetic  errors  prior  to  or  after  sailing.  It  seems  to  be  a  disturbance  of 
equilibrium  partly  visual  but  mainly  due  to  actual  motion  of  the  vessel, 
and  includes  in  its  symptomatology  and  pathogeny  a  condition  of  shock 
and  gastric  irritability,  sometimes  one  and  sometimes  the  other  being  the 
predominant  cause.  A  voyager  from  the  tonic  of  the  bracing  sea  air  may 
inadvertently  overeat  and  thereby  overtax  his  digestive  organs  and  cause 
vomiting.  Some  voyagers  at  sea  can  leave  the  table,  vomit  the  first  two 
or  three  courses  of  a  dinner,  return  and  finish  the  meal  with  astonishing 
equanimity.  With  such  individuals  nausea  is  not  a  persistent  or  annoy- 
ing symptom.  Others  are  always  nauseated,  but  fail  to  evacuate  the 
stomach  contents,  and  consequently  gi'ow  weak  from  lack  of  food.  Still 
others,  after  severe  experience  with  emesis,  strongly  crave  and  can  actually 


KEFEKENCES  125 

retain  and  digest,  in  defiance  of  all  dietetic  laws,  substances  which  they 
could  scarcely  eat  at  home.  Old  cheese,  dill  pickles,  canned  oysters  and 
similar  incongruities  of  diet  are  indulged  in  without  a  qualm. 

There  is  a  class  of  individuals  of  both  sexes,  though  the  greater  num- 
ber are  women,  who  become  so  ill  at  sea  that  they  reach  a  serious  condition 
of  prostration,  with  whom  the  mere  idea  of  food  or  even  the  suggestion 
from  reading  an  elaborate  menu,  will  produce  nausea.  Certain  cases 
are  almost  entirely  free  from  vomiting,  even  from  nausea  in  the  ordinaiy 
secondary  sense,  and  from  any  definitely  localized  pain,  but  consist  in  a 
state  of  general  medical  shock  with  intense  discomfort. 

REFERENCES 

1.  Fitch,  W.  E.     Pediatrics,  Oct.,  1912. 

2.  VON  jSTookden.    Physiology  of  Metabolism,  pub.  by  Keener,  Chicago. 

3.  Thompson,  W.  Oilman.     Practical  Dietetics,  pub.  by  D.  Appleton 

&  Co.,  New  York. 

4.  De  Long,  George  W.     The  Voyage  of  the  Jeannette,  Journals  of 

George  W.  De  Long,  1883. 

5.  Oswald,  Felix  L.    Asclepiades,  Household  Remedies,  215. 
G.     Of  Good  Workes,  and  First  of  Fasting,  pub.  in  16th  century. 

7.  The  Bible.     Neh.  ix,  1 ;  Esther  iv,  3 ;  Judges  xx,  26 ;  I  Sam.  vii, 

6;  II  Sam.  xii,  16;  Dan.  x,  2,  3;  Jonah  iii,  7;  Isa.  Iviii,  3-6; 
Matt,  iv,  2;  Matt,  vi,  16-18;  Matt,  xvii,  21;  Mark  ix,  29; 
Acts  x,  30 ;  Acts  xiii,  3 ;  Acts  xiv,  23 ;  Acts  xxvii,  9  ;  I  Cor.  vii, 
5,  etc. 

8.  PuLLEK,  Rev.  Fkederick  W.     Concerning  the  Fast  before  Com- 

munion, page  36. 

9.  De  Moleme,  Robert.     Fasting,  IIydrotheraj)y  and  Exercise,  page 

59. 

10.  Dewey,  E.  H.    The  True  Science  of  Living,  page  95. 

11.     .    Ihid.,  page  161. 

12.  Chittenden,  R.  H.     Century  Magazine,  Oct.,  1905,  p.  860. 

13.  Stark,  William.     See  works  by  this  author,  pub.  London,  1788. 

14.  Benedict,  A.  L.     Golden  Rules  of  Dietetics,  pub.  by  Mosby  Co. 

15.  VON  NooRDEN.    MctaboHsm  and  Practical  IFedicine. 

16.  Kemp,  Robert  Coleman.    Diseases  of  the  Stomach,  Intestines  and 

Pancreas,  pub.  by  W.  B.  Saunders  Co, 

17.  Aaron,  Ciiaklks  D.     J.  Am.  Mod.  Ass.,  1914,  Ixii,  2021. 


126    FACTOKS  IN  DIET,  DIGESTIOIT  AND   ASSIMILATION 

BIBLIOGRAPHY 

Chambeks.    Manual  of  Diet  in  Health  and  Disease. 

Chittenden.     The  Nutrition  of  Man. 

Flint.    Physiology  of  Man,  New  York. 

GouLEY,  J.     Dining  and  Its  Amenities,  pub.  by  Rebnian  Co.,  1907. 

NivEN,  James.    Feeding  in  Ilelation  to  the  Health  of  the  Young,  1904. 

Thompson,  W.  Oilman.     Diet  in  Relation  to  Age  and  Activity. 

See  Life  of  William  Stokes  in  Masters  of  Medicine. 


CHAPTER   VI 


OVERFEEDING   AND    UNDERFEEDING 


In  these  days  of  overflowing  American  plenty,  superalimentation,  with  its  phy- 
siological  penalties  and  economic  waste,  is  possibly  more  prevalent  than  under- 
feeding, because  of  the  sybaritic  indulgence  in  the  pleasures  of  the  table  in  the 
absence  of  the  physical  stress  of  more  primitive  social  conditions.  And  when  appe- 
tite becomes  pathologically  exaggerated,  the  physician  of  today  knows  no  remedy; 
when  it  fails  in  disease,  he  dispenses  the  "bitter  herb"  of  tradition — and  hopes  for 
the  best. 


Superalimentation:  Overfeeding,  Acute  Overfeeding,  Chronic  Overfeeding; 
Overeating — Chronic  Overeating,  Gourmet,  Gourmand,  Glutton; 
Effects  of  Overeating — Biliousness,  Intestinal  Toxemia,  Effects  on 
Mental  Powers;  Habitual  Overeating — Alimentary  Toxemia,  Effect 
on  Internal  Secretions,  Effects  on  Children,  Aged,  Early  Life,  Idiosyn- 
crasy ;  Metabolism  of  Overfeeding — Excess  of  Proteins  and  Carbohy- 
drates, Convalescents. 

Underfeeding:  Chronic  or  Habitual  Underfeeding;  Maleficent  Sequences  of 
Underfeeding — Mental  and  Physical  Deterioration,  Diminished  Re- 
sistance to  Cold  and  Exposure,  Disease,  Effect  on  Digestive  Organs, 
Underfeeding  a  Cause  of  Drinking  and  Crime;  Protein  Metabolism; 
Pathology  of  Metabolism  of  Starvation — Consumption  of  Energy  in 
Chronic  Malnutrition,  Protein  Metabolism  in  Acute  Starvation,  Se- 
cretion of  Bile,  the  Blood,  the  Urine;  Conclusions. 


SUPERALIMENTATION 

Of  the  terms,  overfeeding  and  overeating,  the  latter  is  the  more  apt 
to  a]iply  to  an  adnlt,  as  children  are  fed,  while  men  and  women,  who 
have  come  into  the  full  possession  of  their  mental  faculties  and  reasoning 
jwwers,  may,  of  their  own  volition,  eat  too  much.  Overfeeding  from  the 
"medical  standpoint  will  be  discussed  later. 

It  is  no  easy  matter  to  determine  exactly  what  the  word  overeating 
implies.  So  many  circumstances  must  be  taken  into  consideration.  But 
speaking  broadly,  it  may  be  stated  with  little  fear  of  contradiction  that 

127 


128  OVERFEEDING    AXD    UNDERFEEDING 

the  tendency  of  civilized  people,  especially  of  those  who  are  prosperous, 
is  to  eat  more  than  is  good  for  their  health,  mentally  or  physically.  Of 
course,  primitive  people,  when  they  have  the  opportunity,  almost  invaria- 
bly surfeit  themselves,  but  their  powers  of  digestion  and  assimilation  are 
usually  equal  to  the  occa^  ion.  Again,  poor  people,  when  temporary  pros- 
perity admits  of  the  indulgence  of  their  appetite  for  food,  are  inclined  to 
gorge  themselves. 

Overfeeding — However,  acute  overfeeding^  as  it  may  be  termed,  does 
not  call  for  an  extended  consideratiou.  It  is  true  that,  in  the  old  days, 
it  has  been  recorded  more  than  once  that  individuals  succumbed  to  the 
consumption  of  very  large  quantities  of  food.  For  instance,  King  Henry 
II  of  England  is  said  to  have  died  as  the  result  of  eating  gluttonously  of 
lampreys,  fish  of  which  he  was  immoderately  fond.  But  he,  together 
with  other  historical  examples  of  the  ill  effects  of  overeating,  were  chronic 
indulgers  in  the  pleasures  of  the  table,  and  merely  hastened  their  end  by 
eating  an  unduly  large  meal  of  indigestible  food  material.  A  death  of 
this  description  is  generally  due  to  interference  by  a  distended  stomach 
with  the  action  of  an  enfeebled  heart. 

It  may  be  reiterated  that  people  rarely  die  of  surfeit  in  these  days, 
but  that  chronic  overfeeding,  or  the  habitual  ingestion  of  an  excessive 
amount  of  nutriment,  is  common.  In  addition,  the  question  of  over- 
eating must  now  be  regarded  in  an  altogether  different  sense  from  that 
in  which  it  was  formerly  regarded.  No  longer  does  superalimentation 
mean  tlie  same  as  the  word  in  the  old  sense  signified.  Our  physiological 
standards  of  overeating  have  greatly  changed.  Former  accepted  standards 
have  been  cast  aside,  and  an  entirely  revised  and  very  much  lowered 
physiological  standard  has  been  set  up,  by  which  it  would  appear  that  the 
population  of  the  whole  civilized  world  is  addicted  to  ingesting  more  food 
than  is  in  keeping  with  the  strict  tenets  of  good  health,  and  is  conse- 
quently laying  up  for  itself  divers  kinds  of  pains  and  penalties  affecting 
body  and  mind. 

While  it  is  evident  that  the  food  faddist  is  actively  preaching  his 
gospel  of  extreme  moderation  in  eating,  throughout  the  length  and  breadth 
of  every  cultured  land,  and  that,  like  all  faddists,  he  is  something  of  a 
fanatic,  yet  the  truth  remains  that  there  is  method  in  his  madness,  and 
that  his  deductions  are  based  on  a  sound  and  scientific  substratum  of  fact. 

There  is  no  smoke  without  fire,  and  whenever  an  abuse  exists  on  a  wide 
scale  prophets  will  arise  to  point  the  way  we  should  go.  Food  faddists 
are  prevalent  and  multiply  for  the  very  good  reason  that  abuse  of  food,  so 
far  as  quantity  and  properties  are  concerned,  is  widespread.     There  is 


SUPKRALlMENTATIOi^  129 

no  douLt  tluit  among  the  prosperous  members  of  a  modern  community, 
eating  to  excess  is  a  fre(iuent  vice  or  fault,  ])articularly  among  those 
Avlio  have  been  endowed  with  a  hirge  share  of  this  world's  goods.  It  will 
1)0  tiresome  to  further  enlarge  on  this  phase  of  the  subject,  and  without 
any  more  elaboration  we  will  conclude  that  superalimentation  is  widely 
l)revalent.  More  notice  is  now  taken  of  the  matter,  because  the  popula- 
tion of  the  world  has  enormously  increased,  and  therefore  the  food  ques- 
tion is  all  important;  and  also  because  a  new  physiological  standard  has 
been  erected  by  scientific  men  who  have  delved  into  the  matter,  the  out- 
come of  whose  findings  is,  on  the  whole,  recognized  as  correct  by  the  scien- 
tific medical  profession. 

But  before  going  into  the  question  from  the  more  scientific  standpoint, 
it  may  be  as  well  to  discuss  superalimentation  from  the  general,  rather 
tl'.an  scientific,  aspect. 

Overeating — Overeating  is  very  liable  to  become  a  habit,  and  with 
indulgence  the  habit  becomes  a  vice.  A  moderate  excess  of  food  is  prob- 
ably not  only  harmless  but  even  good  for  the  health.  For  those  who 
work  hard  in  the  open  air,  of  course,  a  considerable  amount  of  nourishing 
food  is  required ;  for  sedentary  workers,  a  gi'eat  deal  less  aliment  is  indi- 
cated, but,  as  a  rule,  it  is  wise  to  allow  a  certain  amount  of  leeway,  with 
regard  to  the  quantity  of  food  ingested.  It  is  an  extremely  difficult  mat- 
ter to  lay  down  hard  and  fast  rules  about  the  amount  of  food  material  an 
individual  should  ingest.  The  personal  equation  must  always  be  con- 
sidered. Regarding  the  matter  from  the  wide  outlook  of  the  mass  of  tb.e 
population,  it  can  be  said,  with  as  much  dogmatism  as  it  is  right  to  place 
on  any  statement,  that  the  average  fairly  healthy  person  living  in  the  ordi- 
nnry  civilized  community,  will  take  no  harm  and  probably  may  benefit 
from  ingesting  more  food  than  the  amount  that  is  laid  down  by  scientific 
('xjierts,  as  furnishing  snthcient  nourishment  energy  for  tli(i  smooth  and 
erticient  working  of  the  liunuin  machine.  It  may  occur,  and  will  occur, 
that  an  unexpected  and  severe  strain  may  be  put  on  this  machine,  and  in 
order  to  cope  successfully  with  or  resist  this  extra  pressure  without  injury 
to  its  delicate  mechanism,  some  reserve  force  is  needed.  A  mental  strain 
or  physical  strain  may  call  for  the  existence  of  such  a  reserve,  although 
naturally  the  chief  reason  wall  be  that  one  is  compelled  to  go  without  food 
for  a  protracted  period.  In  this  event,  a  reserve  of  food  within  the  body 
will  greatly  assist  in  maintaining  the  vital  forces  and  is  indeed  necessary 
to  ofl^set,  to  some  extent,  the  drain  caused  by  lack  of  food.  It  is  obvious 
that  such  a  reserve  can  only  be  insured  by  eating  moi-e  food  than  the  body 
actually  requires  to  meet  its  necessities.     It  is  by  following  this  principle, 


130  OVERFEEDING    AND    UNDERFEEDING 

by  instinct,  probably,  that  primitive  men  and  animals  embraced  the  oppor- 
tunity whenever  it  presented  itself,  of  gorging  themselves  with  food. 

Following  a  similar  line  of  reasoning,  the  consumption  of  an  especially 
large  meal  on  Sunday  by  workmen  can  be  explained  and  condoned  from 
the  physiological  standpoint.  By  eating  very  heartily  on  at  least  one  day 
of  the  week  the  workman  is  putting  by  a  reserve  supply  from  which  to 
partially  draw  the  energy  needed  throughout  the  week. 

A  surplus  of  this  kind  can  hardly  be  termed  an  excess,  and  it  is  with 
acute  and  chronic  overeating  that  we  are  concerned. 

It  has  already  been  stated  that  although  persons  have  been  known  to 
die  of  a  surfeit,  the  occurrence  in  modern  times,  at  any  rate,  is  extremely 
infrequent.  The  harmful  effects  of  too  great  a  consumption  of  food  at 
one  time  are  local  rather  than  general.  The  digestive  organs,  chiefly, 
suffer,  ^"omiting  may  result  and  may  relieve  the  overtaxed  stomach,  or 
if  the  food  reaches  the  intestine  it  will  probably  decompose  before  it  is  all 
absorbed,  and  diarrhea  in  this  instance  will  act  as  a  safety  valve. 

If  the  process  of  assimilation  does  not  keep  pace  with  that  of  absorp- 
tion, some  of  the  surplus  products  of  digestion  will  pass  out  of  the  system 
by  way  of  the  blood  stream,  that  is,  with  the  assistance  of  the  kidneys. 
This  mode  of  rescue  is  one  that  is  not  often  employed,  although,  that  it  is 
on  occasions,  is  demonstrated  by  the  fact  that  a  great  excess  of  protein  in 
the  food  may  give  rise  to  transient  albuminuria.  On  the  other  hand,  if 
the  consumption  of  carbohydrates  has  been  extravagantly  large,  sugar  may 
for  a  time  appear  in  the  urine. 

Chronic  overeating  is  a  different  matter  and  its  ill  effects  are  brought 
about  in  a  more  insidious  manner.  As  a  result  of  excessive  eating  or 
gluttony,  the  stomach  and  bowels  become  enlarged,  the  liver  engorged  and 
a  predisposition  is  established  to  degenerative  changes  of  the  heart  and 
arteries.  The  general  results  of  habitual  overeating  seem  largely  to  depend 
upon  the  food  material  which  forms  the  greater  part  of  the  nutriment 
ingested.  For  example,  if  carbohydrate  or  fat  is  the  food  of  choice,  then 
the  surplus  is  stored  up  in  the  form  of  fat,  and  the  outcome  is  obesity. 
Protein  material  can  hardly  be  stored  in  this  fashion,  for  as  Hutchison 
has  pointed  out,  so  great  is  the  tendency  of  "nitrogenous  equilibrium"  to 
assert  itself  that  the  body  can  only  "lay  on"  protein  for  very  short  periods, 
unless  the  process  of  growth  is  still  going  on.  The  same  authority  is  of 
the  opinion  that  what  usually  appears  to  happen  is  that  the  surplus  protein 
is  split  up  into  two  portions,  one  of  which  contains  most  of  the  carbon  and 
is  probably  converted  into  fat  and  stored  in  that  form,  while  the  nitrogen- 
containing  part  is  broken  down,  but  not,  perhaps,  very  rapidly  and  com- 


SUPERALIMEXTATIOIs^  131 

pletely,  so  that  the  products  which  represent  the  internieJiate  steps  in  its 
destruction  circulate  for  some  time  in  the  blood  before  being  excreted  in 
the  form  of  urea.  Some  of  these  products  may  be  factors  in  the  produc- 
tion of  such  conditions  as  granular  degeneration  of  the  kidneys,  high 
arterial  tension,  gout  and  rheumatism.  Many  observers  think  that  they 
are  partly  responsible  for  diseases  of  this  character,  but  the  more  conserva- 
tive and  the  majority  of  those  who  have  made  a  special  study  of  the  sub- 
ject prefer  to  reserve  their  decision  and  to  await  more  definite  proof 
before  laying  down  the  law  on  these  points.  In  this  connection,  it  is  well 
to  bear  in  mind  that  an  excess  of  protein  sparers  in  the  blood  may  produce 
very  similar  results  to  an  excess  of  protein  itself  by  shielding  the  latter 
from  complete  and  rapid  oxidation. 

It  may  be  taken  as  proved  that  gourmandizing  or  gluttony,  whether 
done  only  on  occasions  or  pursued  as  a  habit,  is  by  no  means  beneficial  to 
the  physical  or  mental  attributes  of  the  human  organism.  Chronic  gour- 
mandizing is  more  injurious  to  health  by  far  than  the  occasional  stuffing 
one's  self  with  food,  as  it  is  doubtful  whether  an  occasional  excess,  unless 
carried  to  the  extreme,  is  harmful. 

On  the  mental  faculties  eating  to  excess  has  a  remarkably  pernicious 
effect,  but  before  dealing  with  some  of  the  ills  of  the  body  and  mind,  in- 
duced, fostered  and  aggravated  by  overloading  the  stomach  and  intestine 
and  overtaxing  the  digestiv^e  powers  by  greedy  eating,  gluttony  from  the 
historical  standpoint  will  be  briefly  discussed.  There  have  been  some 
notorious  gluttons,  and  there  have  been  and  are  races  of  people  who  appear 
to  have  an  abnormal  capacity  for  eating,  and  there  are  civilized  individuals 
at  the  present  time  who  exhibit  wonderful  powers  of  consuming  portentous 
quantities  of  food. 

There  is  a  French  proverb :  "Ceux  qui  s'indigerent  ou  qui  s'erviverent 
ne  savent  ni  hoire  ni  manger"  (Those  who  eat  to  surfeit  or  tipple  to  satu- 
ration know  not  how  to  eat  or  drink).  Such  as  these  are  gluttons  in  con- 
tradistinction to  epicures  or  gourmets.  The  epicure  is  an  artist  in  the 
choice  of  food  and  generally  indulges  somewhat  sparingly  in  carefully 
selected  food  and  rare  viands,  while  the  glutton  is  a  gross  consumer  of 
coarse  food  and  strong,  crude  drinks.  The  gourmet  is  a  dainty  eater, 
while  the  glutton  is  a  boorish  consumer  of  immense  quantities  of  heavy 
food.^  The  word  gluttony,  which  expresses  precisely  the  act  of  eating  to 
excess,  is  derived  from  the  Latin  glutire,  to  glut,  to  swallow  greedily,  to 
gorge,  to  devour.  As  the  French  are  the  acknowledged  arbiters  of  artistic, 
refined  eating,  they  possess  in  their  language  several  terms  to  denominate 

1  Anonymous  author  in  "Dining  and  Its  Amenities,"  publisliod  by  Rebman  Co. 


132  OVEKFEEDING   AND    UNDERFEEDING 

and  distinguish  between  the  various  kinds  of  eaters.  Some  French  wi'iters 
make  nice  distinctions  between  the  appellations  goui'mand  and  glutton. 
The  gourmand,  they  say,  loves  good  cheer,  but  eats  with  judgment.  The 
glutton  devours  noisily  and  greedily  all  food  upon  which  he  can  lay  his 
hands.  The  older  editions  of  the  Academy's  dictionary  make  no  such  dis- 
tinctions, and  look  upon  the  gourmand  as  synonymous  with  the  glutton, 
and  many  French  writers  accept  this  definition.  In  the  most  correct 
French  of  the  present  time,  the  word  gourmet  is  used  in  place  of  gourmand, 
meaning  a  careful  eater,  but  a  connoisseur  of  the  art  of  dining.  In  the 
English  language  glnttony  is  practically  identical  with  gourmandizing, 
greediness,  edacity,  gulosity  and  voracity.  (Jlnttony,  however,  is  the  word 
most  frequently  in  use  to  define  the  possession  of  an  insatiable  appetite 
for  food.  The  boa  constrictor  may  be  regarded  as  the  supreme  type  of 
the  colossal  glutton.  Though  perhaps  not  wholly  in  place  in  a  work  on 
diet,  it  may  be  remarked  that  gluttony  is  often  employed  metaphorically 
when  reference  is  made  to  men  who  give  themselves  up  to  excessive  mental 
effort.  Thus  a  hard-working  business  or  professional  man  is  called  a 
glutton  for  work ;  the  elder  Pliny  was  termed  by  a  contemporary  a  literary 
glutton  on  account  of  his  custom  of  mentally  devouring  every  kind  of  ac- 
cessible writing..  The  individual  who  indiscriminately  devours  writings 
of  any  kind,  being  able  to  assimilate  only  a  small  part  of  them,  is  as  much 
of  a  literary  glutton  as  the  voracious  devourer  of  any  sort  of  food  is  a 
glutton  in  the  ordinary  sense  of  the  word. 

The  glutton  living  in  a  civilized  country  differs  from  his  primitive 
brethren  and  his  somewhat  more  distant  relatives,  the  carnivora  and 
omnivora,  in  that  their  appetite  is  instinctive  and  natural,  while  his  is 
abnormal  and  not  infrequently  morbid.  There  are  men  who  are  large 
eaters  without  being  gluttons.  The  human  glutton  is  in  a  class  by  him- 
self and  is  marked  by  certain  unpleasant  but  significant  characteristics. 
He  is  essentially  a  gross  eater  to  whom  quantity  is  of  more  importance 
than  quality  and  who  persistently  and  with  intent  gorges  himself  to  reple- 
tion. Of  course,  there  are  gluttons  who  should  be  named  rather  gour- 
mands, for,  after  all,  there  is  a  shade  of  difference  between  the  terms; 
gourmands,  while  immense  and  voracious  eaters,  are  nevertheless  careful 
in  choice  of  food  and  drink.  Of  all  the  gluttons  whose  names  appear  in 
history,  that  of  the  greedy  Heliogabalus  comes  to  mind  as  the  archetype  of 
gluttony.  Alexander  the  Great,  who  was  glutton  in  everything,  died  at  an 
early  age  from  the  effects  of  a  protracted  debauch,  and  the  Emperor  Sep- 
timus Severus  succumbed  to  acute  indigestion  brought  on  by  overeating 
and  vinous  excess. 


SUPERALIMENTATION  133 

The  glutton  is  limned  to  the  life  hy  the  inimitable  art  of  Shakespeare 
in  the  person  of  Sir  John  Falstaft" ;  in  many  of  the  immortal  bard's  plays 
vivid  and  lifelike  verbal  pictures  of  the  glutton  are  presented.  In  the  time 
of  Shakespeare,  be  it  remembered,  gross  eating  and  heavy  drinking  were 
customary,  and  in  polite  society  the  glutton  was  not  looked  at  askance. 
To  be  a  good  trencher  man  was  esteemed  a  virtue  rather  than  a  vice.  To 
hark  further  back  tJian  the  time  of  Shakespeare  to  that  of  another  of  the 
greatest  poets  of  the  world,  Homer,  we  find  that  to  eat  gluttonously  and 
to  drink  unstintedly  was  regarded  as  an  almost  necessary  attribute  of  a 
good  fighting  man.  As  it  was  heroic  to  kill  one's  enemies,  so  it  was  the 
part  of  the  militant  hero  to  consume  unlimited  quantities  of  food  and 
drink.  As  an  historical,  possibly  legendary,  example  of  capacity  for  food, 
it  is  related  in  the  verses  of  the  poet  Berchoux,  who  told  in  charming 
rhymes  of  the  pleasures  of  the  table  and  of  the  doughty  deeds  of  his  gas- 
tronomic heroes,  that  during  one  morning  Albinus  consumed  five  hundred 
figs,  one  hundred  peaches,  ten  melons,  twenty  pounds  of  muscat  grapes, 
one  hundred  fig  pickers  and  four  hundred  and  eight  oysters.  Truly  there 
were  gastronomic  giants  in  those  days. 

The  Tartiars  have  always  been  conspicuous  as  great  meat  eaters  and 
heavy  drinkers,  and,  if  their  powers  in  this  direction  have  not  been  belied, 
Genghis  Khan,  Tamerlane  and  others  of  the  earlier  Tartar  warriors  well 
upheld  the  traditions  of  their  race  as  carnivorous  gluttons.  Of  European 
people  the  Norsemen  and  the  Saxons  ate  and  drank  inordinately,  while 
the  Normans  were  more  fastidious  in  their  choice  of  food. 

Louis  XIV  of  France  was  a  voracious  eater.  It  is  told  by  chroniclers 
of  his  time  that  he  frequently  ate  at  one  sitting  four  plates  of  different 
soups,  a  whole  pheasant,  a  partridge,  a  copious  serving  of  salad,  some 
roast  mutton,  two  good  sized  slices  of  ham,  a  fair  share  of  pastry,  and  for 
dessert  preserved  fruits,  nuts,  etc.  A  very  favorite  dish  of  his  was  hard 
boiled  eggs.^ 

Charles  Y  was  as  big  a  glutton  as  he  was  an  epicure.     At  a  dinner  of 


1  Of  old  tho  palate  ran  riot.  The  Romans  were  both  epicures  and  gluttons.  The 
oysters  of  Britain  were  conveyed  by  relays  of  runners  to  the  Roman  villas.  One  epicure 
cast  a  slave  into  his  fishpond  to  improve  the  flavor  of  his  '.ampreys.  The  most  absurd 
dishes  were  contrived,  up  to  a  pie  of  nightingales'  tongues.  Their  tastes  were  not 
ours.  Fowls  were  boiled  in  aniseed  water,  and  served  with  a  sauce  containing  aniseed, 
mint,  mustard  seeds  and  asafetida.  Nor  were  the  middle  ages  far  different.  Charles 
TV.  of  Germany,  was  a  notorious  gourmand.  Besides  ordinary  meats  he  had  roasted 
horse,  cats  in  jelly,  lizard  soup,  fried  frogs,  etc.,  till  bis  chef,  when  asked  for  a  new 
dish,  could  only  suggest  a  compote  of  watches — in  allusion  to  that  monarch's  passion" 
for  such  timekeepers. 

109 


134  OVEKFEEDING   AND    UNDERFEEDING 

the  Knights  of  the  Golden  Fleece,  Roger  Ascham  saw  him  make  his  way 
through  sod  beef,  roast  mutton  and  baked  hare,  after  which  he  fed  full 
well  on  a  capon.  Nor  did  he  forget  to  drink  with  it  all.  "He  had  his 
head  in  the  glass  five  times  as  long  as  any  of  them,  and  drank  no  less  at 
once  than  a  quart  of  Rhine  wine."  It  is  further  narrated  that  he  became 
a  victim,  of  gout. 

In  more  modern  times  the  Due  d'Escars  died  within  twelve  hours  after 
eating  too  freely  of  the  famous  dish  of  truffles  a  la  puree  d'ortolans,  de- 
vised by  Louis  XVIII. 

Overeating  generally  is  more  prevalent  in  modern  times  and  among 
civilized  communities  than  in  the  days  of  yore,  for  the  reason  that  there 
are  more  persons  who  can  afford  to  indulge  their  proj^ensities  in  this  direc- 
tion. Per  contra,  there  are  fewer  people  who  eat  and  drink  to  an  im- 
moderate extent.  While  the  ancient  vice  of  gluttony  has  been  handed 
down  from  generation  to  generation,  there  are  few,  if  any,  instances  of 
unbridled  voracity  which  can  be  compared  with  those  told  in  the  annals 
of  great  gastronomic  feats.  Still  the  race  of  gluttons  is  by  no  means 
extinct,  and  it  will  be  pertinent  to  cite  a  case  or  two  of  gluttony  carried 
to  extreme  limits,  by  modern  emulators  of  the  gourmandizing  exploits  of 
men  of  ancient  times  and  of  the  middle  ages.  Savarin  in  his  fourth 
"Meditation,"  section  "Grands  Appetits,"  states  that  a  General  Bisson 
drank  eight  bottles  of  wine  with  his  copious  breakfast,  and  that  Prosper 
Sibuet,  when  eighteen  years  of  age,  on  a  wager,  devoured  a  whole  turkey 
after  having  eaten  a  bountiful  dinner. 

Sergeant  M.  A.  Hunter,  Quartermasters'  Corps,  U.  S.  A.,  related  to 
the  author  that  he  witnessed  an  exhibition  of  abnormal  capacity  for  ingest- 
ing food  when  he  was  stationed  at  Fort  Apache  just  before  the  outbreak 
of  the  Spanish-American  War.  A  detachment  of  raw  recruits  were  sent  to 
Fort  Apache,  and  among  these  were  several  Poles  and  Russians,  who  were 
enormous  meat  eaters.  The  Sergeant  says  that  the  quantity  of  meat  these 
men  could  consume  quickly  attracted  the  attention  of  the  Mess  Sergeant 
of  the  company,  and  a  gourmandizing  trial  of  strength  was  arranged  be- 
tween the  champions  of  each  race.  After  a  lengthy  encounter  the  Rus- 
sian gained  the  victory,  having  swallowed  23i/>  pounds  of  roast  rare  beef. 

Reference  was  made  in  a  former  part  of  this  chapter  to  the  eating 
powers  displayed  by  certain  races,  and  in  the  opening  chapter  of  the  first 
volume,  dealing  with  the  evolution  of  man's  diet,  some  examples  were 
given  of  these  powers.  Of  races  which  inhabit  the  world  at  the  present 
time,  the  Eskimo  stands  supreme  as  a  devourer  of  meat.  Cook  stated  that 
they  eat  but  one  meal  a  day  and  then  gorge  themselves  with  tough  meat 


SUPEKAJJMENTATION  135 

so  that  they  develop  big  jaws  and  ciiorinously  distended  abdomens.  Hayes, 
on  an  exploring  expedition,  had  an  opportunity  to  study  the  habits  of  these 
people,  and  says  that  it  is  not  uncommon  for  an  Eskimo  to  eat  from  12  to 
15  pounds  of  food,  about  one-third  of  which  is  fat  and  the  rest  muscle 
meat.  Captain  Hall,  when  on  his  Arctic  expedition,  declares  that  he  saw 
a  native  Eskimo  eat  20  pounds  of  raw  meat  and  consume  a  quart  of  train 
oil  within  24  hours. 

Many  primitive  people  of  the  present  day  both  in  tropical  and  cold 
climates  eat  immensely,  but  as  said  before,  while  eating  too  much  has  , 
increased  generally  in  civilized  countries,  cases  of  inordinate  eating  are" 
more  rare.  Gluttony  in  civilized  people  is  regarded  not  only  as  a  sin 
against  the  laws  of  health,  but  as  a  repulsive  means  of  gratifying  the 
sensual  appetites,  fraught  with  the  most  grave  consequences.  It  is 
frowned  ui)on  and  stignuitizod  in  })olite  sfx^iety,  and  he  who  sins  in  this 
respect  is  looked  npon  with  contempt. 

Effects  of  Overeating. — The  effects  of  overeating  on  the  mind  and 
body  are  more  or  less  obvious.  Overeating  causes  congestion  of  the  liver, 
and  a  condition  known  as  "biliousness/'  in  which  the  stomach  and  intes- 
tines are  engorged.  Constipation  ensues,  the  tongue  becomes  heavily 
coated,  the  bodily  secretions  are  altered  in  composition,  and  the  urine 
especially  becomes  overloaded  with  salts.  It  is  evident  that  we  are  not 
nourished  by  the  food  we  eat,  but  by  the  amount  we  can  properly  use  and 
assimilate.  Probably,  an  excess  beyond  this  amount  is  beneficial  because 
it  supplies  a  reserve  upon  which  the  body  can  depend  for  nourishment  in 
time  of  need.  However,  it  is  absolutely  patent  that  chronic  overeating 
so  clogs  the  machinery  of  the  body  that  the  organs  of  elimination  and 
excretion  are  unable  to  work  as  they  should,  intestinal  stasis  follows,  the 
surplus  food  material  putrefies  before  it  is  absorbed  in  the  intestine,  the 
urinary  tract  becomes  infected,  the  circulation  becomes  involved  in  the 
toxic  invasion,  and  the  whole  system  is  poisoned. 

This  condition  of  intestinal  toxemia  brings  in  its  train  many  mental 
and  physical  disabilities.  The  nervous  and  muscular  systems  become 
saturated  with  the  end  products  of  protein  digestion,  producing  a  state 
of  lassitude,  headache,  fatigue,  drowsiness  and  even  mental  stupor. 

The  effect  of  chronic  overeating  on  the  mental  powers  is  very  evi- 
dent. Indeed,  it  may  be  laid  down  as  an  axiom  that  a  person  who  habit- 
ually overeats  is  incapable  of  good  or  sustained  mental  work.  The  cross, 
irritable  dyspeptic  is  too  greatly  occupied  in  worrying  about  his  own  ills 
to  be  able  to  employ  his  mental  faculties  in  other  and  more  useful  chan- 
nels.    The  brain  worker  or  business  man,  who  eats  largely,  especially  in 


136  OVERFEEDING    AXD    UNDERFEEDING 

the  middle  of  the  day,  cannot  use  his  mental  powers  properly.  His  mind 
loses  its  acuity  and  as  for  flights  of  imagination,  if  he  is  a  literary  man, 
these  are  impossible.  Overeating  is  an  insurmountable  obstacle  in  the 
way  of  mental  endeav^or.  The  handicap  placed  upon  the  entire  system  as 
the  result  of  overeating  is  too  great  to  be  overcome,  and  the  mind  refuses 
to  respond  to  the  stimulus  of  thought. 

HABITUAL  OVEREATING.— The  effects  of  overeating  on  the  body  have 
been  discussed  already,  and  little  remains  to  be  added.  It  is  known  that 
habitual  eating  to  excess  will  in  course  of  time  bring  about  alimentary 
toxemia,  and  it  is  more  than  surmised  that  this  poisoning  of  the  system 
by  the  waste  food  products  is  mainly  and  sometimes  wholly  responsible 
for  many  serious  diseases,  the  maladies,  for  instance,  so  frequent  in  these 
days,  known  as  chronic.  However,  until  our  knowledge  on  these  points 
is  more  exact  and  definite,  it  would  be  unwise  to  si)eak  very  dogmatically, 
that  is  to  say,  it  would  be  unwise  to  say  with  decision  that  such  and  such 
a  disease,  gout  or  rheumatism,  for  instance,  is  caused  chiefly  by  overeat- 
ing or  errors  of  diet.  This  we  do  know  and  can  state  emphatically,  that 
in  the  treatment  of  conditions  of  this  nature,  diet  plays  a  very  important, 
if  not  the  most  important,  role. 

There  is  another  point  in  connection  with  habitual  overeating  which 
should  not  be  overlooked,  and  that  is  its  effect  on  the  internal  secretions 
concerned  in  the  digestive  process.  "We  do  not  know  enough  of  the  mode 
of  action  of  the  secretory  glands  to  state  exactly  and  in  detail  what  their 
province  is,  but  we  have  learned  that  they  have  very  much  to  do  with  the 
working  of  the  human  organism  and  that  when  they  secrete  deficiently 
ill  health  follows.  Overeating  no  doubt  unduly  taxes  the  internal  secre- 
tions, and  this  persistent  strain  results  in  their  failure  or  partial  failure 
to  perform  their  normal  functions.  It  is  satisfactory  to  be  able  to  state 
that  knowledge  about  the  internal  secretions  is  increasing  and  that  the 
time  is  approaching  when  the  mystery  that  envelops  them  will  be  cleared 
away. 

Children  are  often  habitually  overfed  and  the  old  frequently  suffer 
from  the  effects  of  chronic  overeating.  There  is  little  doubt  that  many 
of  the  ailments  with  which  babies  and  young  children  are  afflicted  pro- 
ceed from  overfeeding.  With  most  mothers  the  criterion  of  an  infant's 
health  is  the  amount  of  adipose  deposit  it  carries.  The  fatter  it  is  the 
prouder  its  parents  are  of  it.  The  truth  is  that,  as  a  rule,  the  fat  baby 
is  not  the  healthy  baby. 

The  healthy  baby  can  digest  and  assimilate  easily  and  continuously 
an  amount  of  food  sufficient  to  produce  normal  growth.    An  excess  of  food 


SUPERALIMENTATIO:Nr  137 

will  not  cause  a  corresponding  excess  in  the  rate  of  growth.  A  deficiency 
or  excess  of  food  continued  for  a  length  of  time  may  check  growth.  The 
rickety  child  is  frequently  extremely  fat,  and  it  is  certain  that  harm  will 
result  from  giving  the  infant  too  much  to  eat. 

With  regard  to  overeating  in  the  case  of  the  aged,  it  goes  without  say- 
ing that  the  habit  is  to  be  deprecated.  When  middle  age  comes  digestion 
often  begins  to  lose  its  former  vigor,  and  metabolism  shows  signs  of  flag- 
ging. With  the  gradual  onset  of  old  age  digestive  and  metabolic  activity 
further  wanes.  Consequently  with  the  advance  of  age  chronic  overeating 
should  be  guarded  against  and  simple  foods  should  be  taken  sparingly. 
At  the  age  of  sixty  an  individual  must  reduce  his  intake,  and  at  seventy 
his  power  has  further  diminished  and  the  nutriment  must  correspond 
thereto,  if  he  desires  still  another  term  of  comfortable  life. 

Sir  Henry  Thompson(l)  says:  "I  desire  to  point  out  that  the  system 
of  'supporting'  aged  persons,  as  it  is  termed,  with  increased  quantities  of 
food  and  stimulant,  is  an  error  of  cardinal  importance,  and  without 
doubt  tends  to  shorten  or  embitter  life."  Overfeeding  of  young  children 
and  overeating  in  the  case  of  aged  persons  are  grave  dietetic  errors. 

In  early  life,  as  Campbell  has  p<;)inted  out,  most  people  can  cope  with 
a  dietary  which  departs  widely  from  the  ideal;  they  are  able  to  consume 
with  comparative  impunity  not  only  far  more  food  than  is  required,  but 
also  all  sorts  of  foods  which  in  later  years  cannot  be  tolerated.  "Com- 
parative impunity"  is  said  with  intention  because  chronic  dietetic  delin- 
quencies, even  in  early  life,  cannot  but  be  harmful  in  the  long  run, 
although  an  occasional  la])se  from  a  severely  correct  diet  may  in  the  case 
of  the  habitually  abstemious,  be  actually  beneficial,  and  this  even  after 
middle  life. 

The  point  which  should  be  emphasized  with  regard  to  overeating  is 
that  chronic  eating  to  excess  is  extremely  injurious  to  health,  while  an 
occasional  indulgence  in  this  direction  may  do  good  rather  than  harm. 
Another  point  u])on  which  stress  should  be  laid,  is  that  idiosyncrasy  and 
custom  count  for  a  good  deal  in  the  capacity  of  the  organism  to  cope  with 
different  kinds  and  quantities  of  food.  The  personal  ecpiation  is  always 
an  important  factor.  Individuals  vary  greatly  in  their  digestive  and 
metabolic  ca])acities.  For  exnni]»le,  some  children  are  made  ill  by  even 
a  slight  excess  of  food,  while  their  grandj)arents,  perhaps,  can  consume 
a  large  excess  with  comparative  impunity.  Adults  in  the  prime  of  life 
differ  widely  in  their  digestive  and  metabolic  capacities.  One  man  can 
ingest  without  apparent  injury  an  amount  of  food  which  another  man 
leading  exactly  the  same  kind  of  life  cannot  tolerate.     But  often  the  pos- 


138  OVERFEEDII^G   AND    UNDERFEEDIi^G 

session  of  great  digestive  and  metabolic  capacities  is  of  doubtful . value, 
as  these  are  apt  to  be  abused  and  the  "individual  with  what  is  termed  a 
weak  stomach  frequently  outlasts  the  person  of  strong,  vigorous  frauie 
and  sanguine  temperament,  largely  owing  to  the  fact  that  he  has  to  be 
careful.  The  creaking  gate  frequently  hangs  the  longest.  Also  the  ques- 
tion of  heredity  plays  a  far  greater  part  than  many  people  imagine. 
Longevity  is  to  a  considerable  extent  a  matter  of  inheritance. 

There  is  another  interesting  point  in  connection  with  overeating  that 
is  deserving  of  passing  mention.  The  capacity  to  cope  with  an  excess  of 
food  differs  in  different  races  irrespective  of  climate  or  conditions  of  life. 
Custom  exerts  some  influence.  Thus  the  Jews  seem  to  be  conspicuous  in 
this  respect.  They  lead,  as  a  rule,  a  sedentary  life,  and  yet  can  habit- 
ually eat  an  excess  of  rich  food  without  apparent  injury  to  health,  pos- 
sibly for  the  reason  that  because  far  longer  than  any  other  race,  on  account 
of  their  prosperity,  they  have  been  able  to  obtain  plenty  of  food,  and  have 
thus  become  racially  adapted  to  it. 

The  question  of  overfeeding  in  contradistinction  to  overeating  will 
now  be  considered. 

Metabolism  of  Overfeeding — Overfeeding,  speaking  from  the  standpoint 
of  the  medical  man,  signifies  that  the  object  to  be  attempted  is  the  build- 
ing up  of  fresh  tissue  in  a  person  previously  badly  nourished  or  who  has 
lost  tissue  as  the  result  of  disease.  Von  Noorden's  definition  of  the  terra 
"overfeeding"  is  the  administration  of  food  in  such  a  quantity  as  to  pro- 
vide more  energy  than  the  needs  of  the  body  require.  According  to  the 
same  authority,  it  is  a  matter  of  indifference  whether  the  excess  takes  the 
form  of  albumin  or  of  some  oxidizable  substance  free  from  nitrogen. 

EXCESS  OF  PROTEINS  AND  CARBOHYDRATES.— If  fat  is  ingested  in 
excessive  amounts  the  greater  part  of  the  energy  thus  created  passes  into 
tissue  substance.  Carbohydrates  consumed  to  an  excessive  extent  do  not 
afford  nutriment  to  the  tissues  in  the  same  way.  Zuntz(2)  has  estimated 
that  considerably  less  energy  is  generated  for  digestive  purposes  by  carbo- 
hydrate consumption  and  that  with  coarse  kinds  of  bread  the  energy  loss 
is  much  less.  In  addition,  it  has  been  shown  by  Rubner  and  Zuntz  that 
carbohydrate  is  not  changed  into  fat  with  absolutely  no  loss  of  heat. 

When  nitrogenous  substances  compose  the  excess  the  results  are  dif- 
ferent from  those  of  fat  on  carbohydrate  excess.  Several  investigators 
seem  to  have  demonstrated  that  in  these  circumstances  the  processes  of 
oxidation  are  augmented.  Rubner(3)  fed  animals  with  a  rich  meat  diet 
and  obtained  values  appearing  to  show  that  a  daily  transformation  of 
energy  exceeding  those  in   accord  with   the  food  necessary  for  main- 


SUPEKALIMENTATION  139 

tcnaiice  by  ^0  or  40  per  (;ent  or  more  was  necessary.  However,  when 
man  is  ocmsidered,  no  large  amounts  need  to  be  taken  into  account. 
From  tlic  fact  that  he  is  omnivorous,  it  is  known  that  only  a  compara- 
tively small  proportion  of  the  food  ingested  can  be  replaced  from  pro 
tein.  Rubner  was  able  to  distinguish  two  effects  as  the  result  of  feeding 
on  protein  substances : 

1.  The  primary  effect  of  a  meal  rich  in  protein  is  an  increase  in  the 
oxidation  processes,  which  passes  oft'  in  about  eight  to  ten  hours. 

2.  In  certain  circumstances,  however,  the  continued  use  of  a  diet 
rich  in  protein  leads  to  a  long  continued  increase  in  the  consumption  of 
energy,,  which  lasts  as  long  as  the  excess  of  protein  remains  high.  This 
increase  in  the  waste  of  energy  rises  more  quickly  in  accordance  with  the 
addition  of  protein. 

From  the  standpoint  of  the  most  recent  investigations,  von  I^oorden(4) 
thinks  that,  in  estimating  the  elements  of  the  food  by  which  an  excess 
of  calories  is  produced  beyond  the  needs  which  form  the  basis  of  a  diet 
to  increase  body  weight,  protein  is  the  leist  suitable  since  along  with  a 
low  caloric  value  the  necessary  oxidation  processes  must  be  considerably 
increased  for  its  combustion.  Consequently,  very  little  of  the  surplus 
calories,  which  result  from  the  excess  of  protein,  are  left  at  the  disposal 
of  the  system.  Howell (5)  points  out  that  if  protein  is  eaten  in  excess 
of  the  real  assimilation  needs  of  the  tissues,  all  the  excess,  as  far  as  we 
can  see,  might  just  as  well  be  substituted  by  carbohydrate  or  by  carbo- 
hydrate and  fat.  The  excess  nitrogen  thus  eaten  api:)ears  to  be  so  much 
useless  ballast  which  the  body  very  promptly  gets  rid  of. 

Better  results  are  obtained  from  carbohydrates,  although  in  their  case 
at  least  one-fourth  of  the  store  of  energy  contained  in  an  excess  of  them 
is  lost  on  the  way  from  the  stomach  to  its  final  storage  as  fat  in  the  fat 
depots.  Von  Noorden  is  of  the  opinion  that  the  conditions  are  most  favor- 
able in  the  case  of  fat,  as  very  little  expenditure  of  energy  is  required 
on  the  part  of  the  digestive  organs,  and  the  fat  is  stored  as  such  without 
any  loss  of  energy.  Rosenfeld(6)  thinks  that  there  is  reason  to  believe 
that  in  animals  like  ourselves  the  carbohydrates  are  more  easily  and  more 
quickly  destroyed  in  the  body  than  the  fats,  and  that,  therefore,  the  latter 
may  be  more  readily  deposited  in  the  tissues,  although  an  excess  of  car- 
bohydrate beyond  the  actual  needs  of  the  body  will  also  be  preserved  in 
the  form  of  fat  or  glycogen.  The  modern  point  of  view  is  that  body  fat 
is  formed  in  the  first  instance  from  food  fat  and  food  carbohydrates.  It 
is  customary  to  teach  and  put  into  practice  the  theory  that  carbohydrates 
or  fat  and  carbohydrates  are  best  adapted   for  feeding  purposes   and, 


140  pVEK FEE  I  )li\G    AND    UNDERFEEDING 

despite  the  opinions  of  von  Noorden,  full  nse  is  seldom  made  of  fat. 
However,  that  anthority  claims  that,  when  certain  pathological  conditions 
of  the  stomach  and  intestines  can  be  excluded,  large  and  even  enormous 
quantities  of  fat  are  well  tolerated,  with  results  that  cannot  be  exceeded 
by  an  abundant  exhibition  of  carbohydrates.  This  remark  may  be  inter- 
polated here  that  while  emphasis  has  been  laid  upon  the  importance  of 
overfeeding,  that  is,  of  providing  what  Meltzer  has  termed  a  "factor  of 
safety,"  a  certain  margin  beyond  a  bare  sufficiency  which  will  be  a  re- 
serve against  unusual  demands,  the  question  may  be  asked — what  consti- 
tutes the  assimilation  need  of  the  tissues  ?  This  must  be  known  with  more 
or  less  accuracy  before  the  amount  of  the  reserve  required  can  be  stated. 
If  a  man  is  accustomed  to  eat  100  grams  of  protein  daily,  and  science 
demonstrates  that  he  can  maintain  a  nitrogen  equilibrium  on  30  grams, 
does  a  reasonable  factor  of  safety  require  the  use  of  the  additional  70 
grams,  or  would  a  less  total  per  day,  perhaps,  meet  every  requirement? 
This  is  a  point  which  should  be  elucidated  by  experiment  and  observation. 
Von  Noorden  is  of  the  opinion  that  the  increase  in  the  exchange  of 
calories  following  the  fattening  of  the  body  tissue  depends  on  the  follow- 
ing two  factors. 

1.  The  increase  in  the  amount  of  protoplasm  disintegrated,  forms  the 
most  characteristic  feature.  When  large  quantities  of  fat  are  put  on,  the 
body  accumulates  material  which  adds  to  its  weight  but  hardly  con- 
tributes at  all  to  the  energy  exchange.  As  a  result,  the  balance  of  energy 
based  upon  the  body  weight  falls,  as  a  rule,  in  individuals  who  are  being 
overfed.  An  addition  of  flesh,  that  is,  an  increase  in  protoplasm,  aug- 
ments the  transformation  of  energy  as  shown  by  experiments  made  by 
Pfluger  and  Kubner.  Zuntz(7)  demonstrated  that  by  systematic  muscular 
exertion,  continued  for  a  considerable  period,  many  of  those  experimented 
uix»n  became  thinner  but  gained  a  good  deal  of  nitrogenous  material. 
When  the  period  of  exertion  was  over  the  exchange  of  calories  was  higher, 
the  casual  factor  being  an  increase  in  the  protoplasm. 

2.  The  increase  in  the  actual  size  of  the  body,  independent  of  the 
formation  of  protoplasm,  necessitates  an  increase  in  the  consumption  of 
energy,  which  means  that  individuals  of  heavy  weight  require  a  greater 
expenditure  of  energy  in  order  to  move  and  raise  their  limbs  and  so  on. 
It  is  not  infrequently  impossible  to  set  up  definite  quantitative  relation- 
ships between  the  addition  of  protoplasm  and  the  increase  in  the  trans- 
formation of  energy. 

In  the  present  state  of  our  knowledge,  it  will  not  be  wise  to  go  further 
than  the  following  statements :  (a)  Every  increase  in  the  amount  of  pro- 


SUPEKALIjMENTATION  141 

toplasm  increases  the  energy  exchange,  {b)  An  increase  in  weight,  due 
to  increased  intake  of  fat,  also  increases  the  energy  exchange,  (c)  With 
the  ingestion  of  further  (juantities  of  protein,  the  energy  exchange  often 
rises  independently  of  the  increase  in  i)rotoplasm,  probably  as  the  result 
of  a  peculiar  irritative  action  of  the  food  proteins  on  the  active  cells,  the 
exact  nature  of  which  is  unknown.  Kraus(8)  points  out  with  regard 
to  the  conditions  wliicli  obtain  in  convalescents  that  it  has  long  been 
known  that  convalescents,  like  those  who  have  been  snbjected  for  a  long 
period  of  time  to  insufHcient  food,  can  be  made  to  increase  in  weight  more 
readily  than  well-nourished  persons.  It  has  been  observed  that  an  addi- 
tion of  protein  can  occur  in  wasted  and  enfeebled  patients  on  a  diet  which 
in  normally  nourished  individuals  would  be  insufiicient  to  permit  a  nitroge- 
nous equilibrium  to  be  attained.  It  was  further  observed  that  especially 
during  convalescence  from  severe  diseases  considerable  amounts  of  protein 
derived  from  the  food  were  daily  retained  in  the  organism,  and  employed 
in  rebuilding  the  damaged  tissues. 

CONVALESCENTS 

Svenson(l))  studied  the  conditions  of  convalescents  during  recovery 
from  typhoid  fever  and  pneumonia,  the  only  ones  as  yet  studied.  In  tl«e 
first  days  after  the  fever  had  disappeared,  the  values  for  oxygen  utilized 
and  the  carbonic  acid  given  off  were  found  very  low.  After  a  few  days, 
however,  the  exchange  of  energy  rose,  and  in  the  following  first  to  second 
weeks  reached  values  which  exceeded  the  normal  by  about  30  to  50  per 
cent.  If,  despite  the  much  more  active  processes  of  combustion,  the 
convalescent  increases  in  weight  and  puts  on  a  good  deal  of  flesh,  this  is 
due  to  the  fact  that  the  taking  up  of  nutriment  is  still  more  decidedly 
raised  than  the  energy  exchange.  According  to  Svenson,  a  food  intake 
equal  to  60  or  TO  calories  per  day  and  per  kilogram  is  not  unusual  in 
the  convalescent.  During  the  period  of  the  nuirked  putting  on  of  pro- 
tein and  fat,  the  respiratory  quotient  rises  considerably.  This  is  exactly 
the  reverse  of  what  is  met  with  in  starvation  when  the  respiratory  quo- 
tient sinks  abnormally.  Von  Noorden  is  inclined  to  doubt  Svenson's 
figures  and  thinks  that  fresh  experiments  in  this  direction  are  called  for. 

An  important  point  is  that  flesh  formation  occurs  in  every  case  in 
which  the  body  has  suffered  from  a  loss  consequent  to  starvation,  under- 
feeding, or  disease,  and  again  returns  to  a  more  satisfactory  state  of 
nutrition.  It  should  also  be  noted  that  the  recuperative  powers  of  the 
organism  with  regard  to  nitrogen  retention  come  into  evidence  when  the 
need  for  calories  is  not  thoroughly  satisfied.     In  this  event,  the  tissues 


142 


OVERFEEDING    AND    UNDERFEEDING 


have  the  preference  when  overfeeding  is  practiced.  It  is  evident  that 
the  conditions  for  flesh  accumulation  are  most  favorable  when  an  excess 
of  food  is  combined  with  the  efforts  at  regeneration  on  the  part  of  the 
organism.  Excess  of  food  can  be  used  to  the  best  advantage  only  when 
the  vital  forces  of  the  subject  are  recuperating.  As  said  before,  the  sole 
exact  experiments  which  have  been  made  hitherto  on  this  aspect  of  metab- 
olism have  been  made  on  convalescents  from  typhoid  fever  and  pneu- 
monia. 

The  following  figures,  taken  from  von  Norden,  when  compared  with 
those  obtained  by  feeding  healthy  individuals,  show  how  markedly  the 
activity  of  the  accumulation  of  nitrogen  is  increased  in  convalescents : 


TABLE  EMPHASIZING  THE  INCREASED  NITROGEN  IN  CONVA- 
LESCENTS, DUE  TO  OVERFEEDING 


Days  of 
Conva- 
lescence 

Nitrogen 

in  Food, 

Gms. 

Calories 
in  Food 

Calories 
per  Kg. 

Daily  accu- 
mulation of 
Nitrogen, 
Gms. 

Weight, 
Kg. 

Observers 

15-27 

18.69 

3,188 

55 

56.5-69.4 

28-36 

20.54 

3,238 

54 

+6.54 

59.4-61.4 

Benedict  and  Sura- 
nyi  (typhoid) 

37^7 

18.63 

3,324 

55 

+7.69 

61.4-64.3 

3-13 

21.3 

3,216 

(average) 

about  56 

+7.56 
+5.92 

about  56 

Ibid,  (typhoid) 

14-17 

21.92 

4,327 

73 

+7.33 

57.5-58.5 

18-25 

17.04 

4,215 

71 

+5.00 

58.5-59.8 

26-34 

28.29 

4,589 

74 

+9.82 

59.8-63.7 

35-42 

27.17 

3,598 

56 

+5.56 

63.7-65.2 

43-62 

27.24 

2,912 

44 

+4.86 

65.2-68.1 

3-13 

18.20 

2,775 

50 

+3.62 

55.0-56.0 

von  Noorden,  1893, 
unpublished  ob- 
servation (ty- 
phoid) 

14-23 

18.20 

2,775 

48 

+4.05 

56.0-59.4 

24-33 

18.20 

2,775 

46 

+5.87 

59.4-61.0 

4-10 

19.10 

2,180 

42 

+3.82 

52.0-52.8 

11-18 

19.10 

2.380 

45 

+4.93 

52.8-54.1 

19-23 

20.20 

2,600 

48 

+3.14 

54.1-56.0 

von  Noorden.  1893, 
unpublished  ob- 
servation (after 
severe  sepsis) 

It  may  then  be  stated  that  the  results  of  experiments  carried  out  per- 
mit the  conclusions  that  the  nitrogen  gain  is  absolutely,  as  well  as  rela- 
tively to  the  simultaneous  putting  on  of  fat,  greatest  in  those  convalescing 
from  severe  acute  diseases.     It  is  less,  but  still  considerable,  in  patients 


SUPERALIMENTATION 


143 


who  were  in  a  condition  of  inanition  before  the  feeding  was  commenced, 
and  whose  body  weight  had  fallen  greatly  below  the  average.  Of  course 
it  follows  that  the  smallest  nitrogen  gain  is  seen  in  individuals  who  were 
well  nourished  before  the  experiment  began. 

The  following  table,  taken  from  von  Noorden,  refers  to  the  manner 
in  which  the  accumulation  obtained  through  feeding  is  divided  between 
nitrogenous  material  and  fat: 


TABLE  SHOWING  APPROXIMATE  VALUES  OF  THE  INTERCHANGE 

OF  NITROGEN  AND  STORAGE,  PROTEIN  AND  FAT,  ABSOLUTE 

AND  PERCENTAGE  IN  OVERFEEDING 


Of  the  Calories  in  Excess 

Food 
Nitro- 

Excess 

THERE  WERE  USED  IN  THE  BoDY 

For  Storage 

For  Storage 

Observers 

gen 
Gra,ms 

of  Cal. 

as  Protein 

as  Fat 

Absolute 

Per  cent 

Absolute 

Percent 

Grams 

Grams 

Grams 

Grams 

Krug 

15.4 

1,537 

115 

7.46 

1,422 

92.54 

Healthy  and  well 
nourished 

Kaufmann  and 

21.5 

1,906 

111 

5.80 

1,795 

94.2 

Healthy  ;moderate 

Mohr 

18.4 

2,775 

170 

6.10 

2,605 

93.9 

state  of  nutrition 

Kaufmann  and 

17.8 

1,683 

133 

8.00 

1,550 

92.0 

As  before 

Mohr 

17.0 

2,830 

204 

7.20 

2,626 

92.8 

30.8 

367 

20 

5.40 

347 

94.6 

30.9 

355 

86 

24.20 

269 

75.8 

Liithje 

41.7 

1,505 

197 

13.10 

1,308 

86.9 

Healthy 

42.6 

1,472 

228 

15.50 

1,244 

84.5 

61.0 

2,524 

482 

19.10 

2,042 

80.9 

Benedict  and 

18.7 

790 

227 

28.70 

563 

71.3 

Convalescent  from 

Suranjd .... 

20.5 

733 

268 

36.60 

465 

63.4 

tjrphoid 

18.6 

738 

263 

35.60 

475 

64.4 

24.3 

830 

206 

24.80 

624 

75.2 

21.9 

1,723 

255 

14.80 

1,468 

85.2 

17.6 

1,594 

174 

10.90 

1,420 

89.1 

Benedict  and 

28.3 

1,868 

342 

18.30 

1,526 

81.7 

Convalescent  from 

Suranyi .... 

27.2 

893 

193 

21.80 

700 

78.2 

typhoid 

27.2 

258 

169 

65.50 

89 

34.5 

18.2 

489 

126 

25.90 

363 

74.1 

von  Noorden. . 

18.2 

387 

210 

54.30 

177 

45.7 

Convalescent  from 

18.2 

316 

204 

64.50 

112 

35.5 

typhoid 

16.8 

342 

70 

20.50 

270 

79.5 

17.2 

468 

49 

10.50 

419 

89.5 

von  Noorden. . 

17.3 

662 

80 

12.10 

580 

87.9 

Stomach  affection 

19.9 

720 

136 

19.00 

584 

81.0 

badly  nourished 

18.0 

558 

143 

25.60 

415 

74.4 

18.1 

707 

118 

16.70 

589 

83.3 

19.1 

1,795 

57 

3.20 

1,738 

9.68 

Hirschfield  .  . . 

23.0 

2,273 

54 

2.40 

2,219 

97.6 

Badly  noiuished 

19.2 

2,197 

115 

5.20 

2,082 

94.8 

144  OVERFEEDING   AND    UNDERFEEDING 

The  argiiment  has  been  brought  against  these  overfeeding  cures  that 
the  increase  of  weight  obtained  soon  disappears.  Probably,  this  depends 
to  some  extent  on  the  manner  in  which  the  treatment  is  conducted.  The 
originator  of  this  therapeutic  method  was  Weir  Mitchell,  who  always 
prescribed  isolation,  complete  bodily  rest,  and  aliment  mainly  of  a  car- 
bohydrate character.  However,  it  is  not  essential  to  follow  Mitchell's 
trophotherapy  to  the  letter,  and  in  many  instances,  exercise  in  the  open 
■  air,  massage  and  so  on  are  indicated.  The  main  object  is  to  admin- 
ister a  large  amount  of  highly  nutritious  food  in  a  relatively  small 
volume  and  whether  absolute  rest  is  to  be  a  part  of  the  treatment,  or 
exercise,  must  be  left  to  the  discretion  of  the  physician.  Personally  we 
shall  advocate  exercise  in  conjunction  with  the  dietetic  regime.  How  long 
the  gain  in  weight  in  consequence  of  overfeeding  can  be  maintained  must 
be  taught  by  therapeutical  experience  rather  than  by  exact  experiments. 

It  has  been  pointed  out  that  in  the  overfeeding  treatment  of  wasted, 
ill-nourished  persons,  during  the  first  weeks  the  body  weight  rises  at  a 
great  rate,  and  this  rise  cannot  be  wholly  explained  by  the  accumulation 
of  flesh  and  fat.  The  explanation  probably  is  the  large  amount  of  water 
taken  up  by  the  blood  and  tissues.  It  is  the  accumulation  of  water  in  this 
manner  that  accounts  for  the  rapid  increase  of  weight  during  the  first 
weeks.  When  diuresis  increases  the  gain  in  weight  slackens  or  stops, 
although  flesh  and  fat  are  still  being  put  on  at  much  the  same  rate. 

The  numerous  investigations  which  have  been  carried  on  within  recent 
years  with  regard  to  the  eflfedts  of  overfeeding  have,  from  the  experi- 
mental standpoint,  been  somewhat  confusing.  While  all  the  investigators 
appear  to  concur  in  the  view  that  overfeeding  is  generally  indicated  in 
cases  of  malnutrition  resulting  from  lack  of  food  or  from  certain  patho- 
logical conditions,  the  explanations  as  to  what  form  of  feeding  should  be 
followed  or  why,  that  is,  from  the  strictly  scientific  point  of  view,  are 
not  altogether  satisfactory.  It  must  be  borne  in  mind  that  up  to  the 
present  time  exact  experiments  on  this  aspect  of  metabolism  have  been 
made  almost  exclusively  on  convalescents  from  typhoid  fever  and  pneu- 
monia, and  even  these  have  been  subjected  to  criticism.  The  explana- 
tions, other  than  those  gained  from  exact  experiments  and  from  clinical 
experience,  are  after  all  no  more  than  scientific  surmises,  although,  of 
course,  they  are  founded  upon  physiological  and  ^pathological  facts  and 
reenforced  by  profound  knowledge  as  in  the  case  of  von  Noorden. 

Moreover,  the  point  raised  by  Howell  is  well  taken:  that,  when  a 
reserve  supply  of  food  provided  by  overfeeding  is  spoken  of,  it  will  be 
necessary  to  find  out  as  nearly  as  may  be  what  constitutes  the  assimilation 


underfp:ei)ing  145 

need  of  the  tissues.  From  the  point  of  view,  then,  of  experiments  with 
regard  to  the  metabolism  of  overfeeding,  the  question  whether  a  genuine 
putting-on  of  flesh  may  bie  obtained  from  this  method  still  remains 
unsolved. 

From  all  the  experiments  made  in  this  direction,  the  most  important 
point  which  has  been  made  clear  is  the  great  selective  power  which  the 
body  possesses  in  regard  to  foodstuffs  given  in  excess.  It  must  be  empha- 
sized that  it  is  only  by  practical  experience  and  not  by  experiments, 
except  those  which  are  generally  conducted  on  animals,  that  we  can  learn 
if  body  weight  can  be  increased  when  this  is  necessary,  if  it  is  to  the 
benefit  of  the  j^atient  to  use  overfeeding  and  if  so  by  what  form  of  food 
this  end  may  be  best  accomplished. 

When  we  turn  to  the  clinical  evidence  on  this  point,  the  results  are 
more  encouraging.  Overfeeding  in  tuberculosis  has  been  referred  to  in 
Volume  I  EI,  Chapter  V,  and  the  treatment  is  likewise  employed  in  cer- 
tain forms  of  anemia  and  chlorosis,  neurasthenia,  hysteria,  visceroptosis, 
nudnutrition  generally  and  especially  in  convalescence  from  various 
diseases,  those  of  a  febrile  and  infective  nature  in  particular. 

Weir  Mitchell's  mode  of  treatment  and  diet  have  been  described  in 
Volume  II,  Chapter  XVI,  and  it  only  remains  to  say  that,  while  the  rest, 
treatment  and  judicious  stuffing  with  food  are  suitable  for  and  have  bene- 
fited many,  yet  whether  this  kind  of  treatment  should  be  followed  or 
whether  a  combination  of  overfeeding  and  exercise  should  be  used  must 
be  left  to  the  discretion  of  the  physician.  We  are  distinctly  inclined  to 
advocate,  as  a  rule,  exercise  and  overfeeding.  Much  the  same  may  be 
said  with  regard  to  the  kind  of  food.  Although  carbohydrate  food  is 
reconnnended  by  perhaps  the  majority,  fat  and  carbohydrate  by  many, 
and  fat  by  von  Noorden  and  others,  there  may  be  cases  in  which  an  excess 
of  protein  food  in  the  shape  of  meat  may  be  of  the  greatest  benefit.  No 
one  dietetic  procedure  should  be  slavishly  followed,  but  the  physician 
should  use  his  own  judgment.  On  the  whole,  overfeeding  by  carbohy- 
drates or  fat  and  carbohydrates  seems  to  have  had  the  best  results. 

UNDERFEEDING 

Underfeeding  is  by  no  means  unconmion  in  civilized  communities 
and  in  urban  and  in  industrial  centers  in  particular.  The  cause  is  gen- 
erally poverty,  as  in  all  modern  countries  there  is  always  a  large  propor- 
tion of  the  inhabitants  who,  while  not  actually  starving,  exist  in  a 
constant  condition  of  semi-starvation.     These  people  not  only  lack  sufii- 


146  OVERI'EEDIN^G    AND    UNDERFEEDING 

cient  food  to  satisfy  their  appetites,  but  they  do  not  ingest  enough 
nutriment  to  keep  their  bodies  in  good  health.  Also,  and  this  is  an 
important  point,  their  diet  is  ill  balanced  and  usually  composed  of 
innutritions  food  products.  If  the  money  they  spend  on  food  were 
expended  judiciously,  that  is,  scientifically,  they  would  not  be  underfed. 
But  in  the  first  place  it  must  be  remembered  that  the  poor  are  compelled 
to  buy  in  the  dearest  market ;  they  obtain  the  least  value  for  the  money 
they  spend,  and  they  are  ignorant  how  to  lay  out  to  the  best  advantage 
the  little  they  possess.  This  is  especially  the  case  with  the  city  poor  of 
the  English  speaking  race.  Probably  no  indigent  people  in  the  world 
buy  food  at  such  high  rates  and  in  such  a  foolish  way  as  those  who  live 
in  the  big  industrial  cities  of  Great  Britain.  In  the  cities  of  America, 
too,  a  large  proportion  of  the  inhabitants  exist  on  an  ill-balanced  diet. 
Perhaps  here  it  is  not  so  much  a  question  of  poverty  as  carelessness  and 
laziness.  The  woman  of  the  household  prefers  to  buy  her  food  ready 
cooked  in  delicatessen  stores  than  to  cook  it  at  home.  The  consequence  is 
that  very  large  numbers  drag  out  a  bare  existence  continually,  on  the 
borderland  of  starvation.  The  Latin  races,  as  a  rule,  live  on  cheap  food 
which  is,  at  the  same  time,  nutritious.  The  Italian,  for  instance,  subsists 
and  does  hard  manual  labor  on  food  like  macaroni;  the  majority  of  the 
inhabitants  of  Japan  work  hard  and  are  muscular  and  vigorous  on  a  diet 
consisting  mainly  of  rice,  and  the  list  of  these  peoples  who  live,  thrive 
and  work  hard  on  an  inexpensive  and  nutritious  diet,  might  be  greatly 
amplified.  However,  the  object  aimed  at  is  to  demonstrate  that 
underfeeding  is  widely  prevalent  in  civilized  lands  rather  than  to  explain 
the  causes.  It  may  be  remarked,  too,  that  children  and  women  are  the 
ones  who  suffer  the  most.  The  man  has  to  have  the  greater  and  best  part 
of  the  food  supply,  because  he  is  the  wage  earner,  and  if  he  were  not  fed, 
however  inadequate  and  ill  chosen  his  food  might  be,  he  would  not  be 
able  to  work  at  all. 

Accordingly,  it  may  be  taken  for  granted  that,  in  civilized  countries 
the  world  over,  a  goodly  portion  of  the  inhabitants  are  underfed;  that 
this  state  of  malnutrition  is  of  various  degrees  of  severity ;  that  it  is  most 
prevalent  in  industrial  countries,  and  that  women  and  children  suffer 
the  most. 

Underfeeding  may  also  occur  when  the  diet  is  normal,  but  the  amount 
of  work  done  is  excessive. 

Chronic  or  Habitual  TTnderfeeding. — Chronic  or  habitual  underfeeding 
is  more  injurious  to  the  health  than  eating  to  excess.  Attention  has 
already  been  drawn  to  the  fact  that  underfeeding  is  quite  as  much  due  to 


tj:n'derfeeding  147 

the  lack  or  deficiency  in  amount  of  one  important  constituent,  as  to 
lack  of  quantity.  It  is  natural  for  a  hungry  person  who  has  little  to 
spend  to  prefer  a  bulky  food  possessing  hardly  any  nutritive  properties  to 
a  more  concentrated  and  highly  nutritious  product.  An  individual  also 
is  largely  governed  by  custom  and  taste.  If  she,  for  the  vs^oman  is  usually 
the  buyer,  likes  tea  and  bread  and  butter  and  a  bony  herring,  a  form  of 
diet  to  which  she  and  her  children  have  become  addicted  by  long  custom, 
these  are  articles  in  which  she  will  invest  her  few  cents.  Therefore,  it 
is  the  absolute  truth  that  malnutrition  is  caused  quite  as  often  by  an  ill- 
balanced  diet  as  by  lack  of  quantity. 

It  is  almost  unbelievable  how  long  a  person  can  live  without  food, 
provided  that  water  is  obtainable.  Professional  fasters  have  frequently 
existed  for  40  days  and  even  longer  with  no  sustenance  except  some  water, 
and  lunatics  have  been  known  to  refuse  food  for  four  or  five  weeks  at 
a  stretch,  all  of  which  seems  to  show  that  starvation  may  be  borne  with 
a  considerable  degree  of  impunity.  In  this  connection,  although  not 
exactly  bearing  on  the  subject  under  discussion,  it  is  interesting  to  know 
that  the  sensations  of  starving  persons  are  not  particularly  unpleasant. 
In  the  popular  mind  prolonged  starvation  is  associated  with  great  pain 
and  distress,  in  spite  of  the  denials  of  those  who  have  undertaken  starva- 
tion voluntarily.  Such  persons,  almost  without  exception,  have  stated 
that,  after  the  first  three  or  four  days  of  starvation,  the  sensation  of 
hunger  is  no  longer  felt,  or,  at  any  rate,  is  not  excessively  painful  or 
uncomfortable.  It  has  been  demonstrated  by  experiment,  that  it  is  only 
Avhen  the  weight  of  the  body  has  fallen  to  one-half  or  one-third  of  its 
original  weight  that  death  from  inanition  ensues.  When  dealing  with 
cases  of  acute  disease,  when  nourishnlent  cannot  be  administered  by  the 
jnouth,  it  is  well  to  remember  these  facts.  According  to  Ilutchison(lO), 
physicians  not  infrequently  may  be  inclined  to  flatter  themselves  that  they 
have  kept  a  patient  alive  by  rectal  feeding,  when  as  a  matter  of  fact  the 
patient  has  been  subsisting  on  the  reserve  supply  which  has  been  stored 
up  for  an  emergency  of  this  character.  He  has,  indeed,  been  living:  on 
himself  or  from  his  own  tissues.  One  need  not  be  unduly  alarmed  if  a 
well-nourished  patient  is  unable  to  take  any  food  at  all  for  a  few  days. 
The  "factor  of  safety,"  his  reserve  supply,  discussed  on  the  previous 
pages  on  overfeeding,  will  in  a  large  number  of  cases  be  able  to  tide  him 
over  the  time  of  stress  without  any  special  injury  to  his  health.  An  ill- 
balanced  diet  is  one  of  the  main  causes  of  chronic  malnutrition.  Nitrogen 
being  the  element  of  which  the  body  is  mainly  built  up,  it  would  seem 
that  a  lack  of  protein  in  the  food  would  be  more  injurious  than  a  defi- 


148  0VERFEEDI:N^G   Al^D    UNDERFEEDING 

cient  supply  of  carbohydrate  or  fat.  The  question  of  the  protein  intake 
has  been  considered  in  Volume  II,  Chapter  Y. 

Suffice  it  then  to  say,  with  regard  to  too  small  a  supply  of  protein  in 
a  diet  otherwise  sufficient,  that,  according  to  Rechenberg(ll)  and  von 
Noorden,  it  is  certain  that  in  cases  where  the  diet  is  full  a  moderate 
diminution  in  the  protein  acts  less  harmfully  than  a  free  supply  of  pro- 
tein with  a  caloric  deficit  in  the  dietary.  In  the  latter  case,  the  body 
goes  on  losing  fat  continuously  and  finally  also  protein ;  in  the  former  the 
loss  in  protein  does  not  go  beyond  a  certain  limit.  The  protein  in 
requirements  may  be  reduced  to  a  comparatively  marked  extent  without 
harm ;  the  caloric  value  of  the  diet,  on  the  other  hand,  cannot  be  lowered, 
or  only  very  slightly.  Von  Noorden  goes  on  to  say  that  it  is  by  no  means 
permissible  to  explain  any  lowering  of  nutrition  or  of  muscular  strength, 
such  as  may  occur  in  certain  classes  or  among  people  living  under 
unfavorable  social  conditions,  as  exclusively  brought  about  by  the  small- 
ness  of  the  protein  intake.  Many,  perhaps  most,  observers,  do  not  agree 
with  von  Noorden  as  to  this  point,  and  Hutchison  expresses  the  most 
widely  held  views  when  he  says  that  an  insufficient  supply  of  protein 
leads  to  imperfect  tissue  repair,  more  especially,  perhaps,  of  the  muscles 
and  blood ;  that  it  causes  the  body  to  become  unduly  watery,  whence  the 
pallor  and  ])uffiness  of  the  underfed ;  and  that  the  combined  effect  of  these 
results  is  to  produce  a  lowering  of  the  power  of  resistance  to  unfavorable 
influences,  including  disease.  A  daily  ration  of  which  the  protein  content 
is  greatly  below  the  standard  of  Chittenden  (many  are  of  the  opinion  that 
Chittenden's  standard  is  too  low),  is  much  more  injurious  than  a  short- 
coming in  respect  to  carbohydrates  and  fat. 

Maleficent  Sequences  of  Underfeeding. — As  the  question  of  underfeed- 
ing with  its  maleficent  sequence  of  untoward  effects  on  body  and  mind, 
appears  to  hinge  largely  on  the  quantity  of  protein  in  the  diet,  and,  as 
this  is  the  phase  of  the  subject  which  has  given  rise  to  the  most  strenuous 
arguments,  protein  in  its  relation  to  malnutrition,  physiologically  and 
pathologically  considered,  will  be  amply  dealt  with  later. 

However,  before  going  into  the  question  of  underfeeding  from  the 
more  scientific  point  of  view,  and  before  attempting  to  sift  the  wheat 
from  the  chaff  in  the  dicta  of  those  who  have  experimented  and  made 
observations  on  the  metabolism  of  underfeeding,  it  may  be  interesting 
and  perhaps  instructive  to  discuss  these  features  from  a  wider  aspect. 
The  effects  of  insufficient  and  injudicious  feeding  are  manifest  on  all 
hands.  The  mind,  the  body  and,  if  the  term  is  allowable,  the  spirit,  are 
injuriously  influenced  by  innutritions  and  insufficient  food.     The  person 


UNDERFEEDING  149 

who  is  ill-fed  deteriorates  in  all  respects.  Underfeeding  is  not  the  sole 
cause,  but  it  is  an  extremely  powerful  contributory  cause. 

With  regard  to  both  mental  and  physical  deterioration  brought  about 
by  an  insufficient  and  ill-balanced  food  supply,  perhaps  the  most  complete 
and  convincing  evidence  was  afforded  by  reports  concerning  prison  expe- 
rience in  this  direction  published  in  1898  in  England.  An  especial  sting 
was  given  to  these  reports,  because  they  were  partially  confirmed  at  the 
time  by  the  gruesome  and  powerful  "Ballad  of  Reading  Gaol/'  written 
by  that  unfortunate  genius,  Oscar  Wilde.  The  Parliamentary  Committee, 
two  of  whom  were  in  the  prison  service,  who  were  appointed  to  report  on 
the  alleged  insufficient  feeding  of  prisoners  and  who  were  certainly  not 
biased  against  the  existing  system,  after  a  searching  inquiry  stated  that 
the  diet  was  inadequate  for  the  labor  on  which  the  prisoners  were 
employed,  that  the  breakfast  and  supper  meals  of  male  convicts  were 
insufficient,  while  the  element  of  fat  in  the  dietary  was  deficient  and 
more  variety  of  food  was  desirable.  It  will  not  be  contended  that  ihe  low 
diet  was  alone  responsible  for  the  breakdown  of  the  health  of  many  pris- 
oners. Other  influences  conducing  to  a  lowering  of  physical  and  perhaps 
mental  resistance  must  be  taken  into  account,  such  as  the  probable  physical 
and  mental  degeneracy  of  a  large  proportion  of  the  inmates,  their  monot- 
onous and  generally  unhealthful  mode  of  life,  and  so  on,  but  it  may 
certainly  be  asserted  that  a  diet  deficient  in  quantity  and  lacking  certain 
essential  nutritive  elements  was  an  important  factor  in  rendering  the 
inmates  especially  prone  to  disease.  Phthisis  in  those  predisposed  to  the 
disease — and  according  to  the  most  recent  views  there  are  few  of  us  who 
are  not  thus  predisposed — is  notorious  for  attacking  those  whose  vital 
resistance  is  weakened  ;  and  the  records  of  prisons  in  which  the  inmates  are 
habitually  underfed  fully  bear  out  this  universally  accepted  theory.  The 
tubercle  bacillus  appears  to  find  a  specially  favorable  soil  in  ill-nourished 
individuals  and  the  association  between  an  insufficient  diet  and  such 
diseases  as  phthisis  and  scrofula  is  so  well  established  that  the  reiteration 
of  the  facts  becomes  almost  tiresome.  Perhaps  tliis  is  why  diabetics,  who 
live  in  state  of  more  or  less  chronic  starvation,  are  so  liable  to  tuberculosis. 

Some  few  years  ago  the  Rt.  Hon.  Charles  Booth  and  Mr.  Rowntree 
inquired  into  and  made  a  report  upon  the  condition  of  the  laboring  popu- 
lation of  England  and  found  that  very  considerable  numbers  of  unskilled 
laborers  were  poverty  stricken  and  chronically  underfed,  not  perhaps  to 
such  an  extent  as  to  cause  immediate  physical  suffering  from  lack  of  food, 
but  yet  enough   to   diminish  working  power  and   to  lead   ultimately  to 

impairment  of   health.      The    power   of   resistance   to   infection    and    to 
110 


150  OVERFEEDING   AND    UNDERFEEDING 

mental  and  physical  deterioration  is  sadly  impaired  in  these  men  and 
even  more  in  their  families,  for  it  cannot  be  too  strongly  insisted  upon 
that  when  a  man  earns  woefully  small  wages,  it  is  the  wife  and  children 
who  suffer  the  most,  and  therefore,  in  the  long  run,  it  is  the  race  and 
nation  who  must  bear  the  brunt  of  underfeeding. 

Large  sections  of  the  community  in  all  countries  are  still  habitually 
underfed.  America,  Canada  and  Australia  compare  very  favorably  with 
Euopean  countries  in  this  respect.  The  reports  from  the  former  lauds 
with  regard  to  the  condition  of  their  working  population  are  not  as  precise 
or  as  voluminous  as  those  from  Great  Britain,  and  consequently  it  is  to 
Great  Britain  that  we  turn  for  accurate  and  full  information  respecting 
social,  economic  and  public  health  conditions. 

Observations  on  the  diet  of  laborers  in  Edinburgh  showed  that  it  con- 
tained an  average  of  107.7  grams,  and  an  energy  value  of  3,228  calories, 
as  opposed  to  the  3,500  believed  to  be  necessary  for  a  man  doing  a  moder- 
ate amount  of  muscular  work.  Mr.  Rowntree's  inquiries  into  the  diet 
of  a  corresponding  class  in  York  yielded  somewhat  similar  results,  the 
protein  average  being  no  less  than  29  per  cent  below  what  is  or  used  to 
be  regarded  as  standard  requirements.  The  Edinburgh  investigators 
(quoted  by  Hutchison)  held  the  view  that  in  order  to  improve  the  dietary 
of  the  laboring  classes,  the  following  principles  should  be  instilled  into 
them:  (a)  That  a  diet  of  tea  and  bread  or  of  tea,  bread  and  butter  is 
faulty;  (h)  that  the  faults  of  the  tea  and  bread  diet  can  be  corrected  by 
the  free  use  of  meat,  eggs,  or  other  animal  food,  but  that  this  mode  of 
correction  is  expensive;  (c)  that  the  faults  can  also  be  corrected  by  the 
free  use  of  oatmeal  with  milk,  or  of  peas  and  beans,  without  extra  cost. 

It  has  been  mentioned  once  or  twice  before  that  the  worst  effects  of 
underfeeding  fall  on  women  and  children,  and  it  is  the  children  who  are 
the  least  able  to  bear  deprivation  of  food,  not  only  from  the  personal  point 
of  view,  but  also,  and  this  is  the  most  essential  feature,  from  the  national 
outlook.  Hippocrates  was  well  aware  that  the  lack  of  food  affected  the 
young  most  injuriously,  as  one  of  his  aphorisms  runs  after  this  fashion, 
"Old  men  bear  want  of  food  best ;  then  those  that  are  adults ;  youths  bear 
it  least,  most  especially  children,  and  of  them  the  most  lively  are  the  least 
capable  of  enduring  it."  The  young  need  plenty  of  nourishing  food  in 
order  that  they  may  grow  up  healthy  and  vigorous,  for  if  a  considerable 
proportion  do  not  have  a  diet  sufficient  and  well  balanced,  they,  if  they 
survive,  will  come  to  maturity  stunted  in  physique.  If  not  actually 
unhealthy,  they  will  lack  vitality  and  will  be  rendered  peculiarly  suscept- 
ible to  infection,  probably  deficient  in  mental  attributes  and  when  not 


UNDERFEEDING  151 

already  steeped  in  crime,  at  least  generally  lacking  that  moral  sense 
which  serves  as  a  bulwark  against  crime.  Such  as  these  fill  our  prisons 
and  asylums ;  they  are  a  menace  to  the  community,  and  their  very  exist- 
ence approaches  a  national  disaster ;  they  propagate  their  like  and  endan- 
ger the  well-being  of  a  nation.  Underfeeding  is  a  prominent  factor  in 
their  production  and  development;  the  remote  results  from  the  health 
aspect  can  only  be  touched  upon.  There  is  no  need  to  elaborate  on  the 
fact  already  strongly  emphasized  that  underfeeding  lays  the  system  open 
to  the  inroads  of  disease. 

Investigations  of  a  searching  and  impartial  character  have  taken 
place  into  the  condition  of  elementary  school  children  in  various  parts  of 
the  world,  including  those  attending  schools  in  parts  of  the  Southern 
States  of  this  country,  and  deplorable  evidences  of  physical  deterioration 
have  been  revealed.  They  provide  conclusive  proof  of  the  hlifjlititifj 
influence  of  parsimony  iri  nutrition  while  growth  is  going  on,  to  say 
nothing  of  diseases  and  defects,  mental  and  physical.  Unfortunately,  this 
does  not  only  signify  a  temporary  setback,  but  a  lasting  damage,  for  the 
manner  in  which  a  child  is  fed  at  the  growth  period  determines  all  sub- 
sequent development.  Dwarfing,  permanent  dwarfing  of  one  kind  or 
another,  is  the  consequence  of  insufficient  feeding  in  early  life. 

Reference  may  be  made  to  the  eifects  of  insufficient  feeding  in 
diminishing  resistance  to  cold  and  exposure.  Sir  John  Franklin,  in 
describing  his  and  his  companions'  journeyings  in  the  Arctic  regions,  said 
that  during  the  whole  of  their  march  they  found  that  no  quantity  of  cloth- 
ing could  keep  them  warm  while  they  fasted,  but  on  those  occasions  on 
which  they  were  enabled  to  go  to  bed  with  full  stomachs,  they  passed  the 
night  in  a  warm  and  comfortable  manner,  which  signified  that  the 
demand  for  heat  in  the  body  was  so  great  that  it  could  no  longer  be  met 
by  diminishing  loss,  but  that  the  deficit  had  to  be  made  up  by  an  increase 
of  heat  production,  that  is,  by  a  greater  consumption  of  food. 

The  influence  that  inadequate  and  unsuitable  food  exerts  on  the 
capacity  of  the  system  for  withstanding  the  efi^ects  of  cold  was  well 
exemplified  by  certain  episodes  of  the  American  Civil  War,  an  account 
of  which  has  been  given  by  Flint(12). 

Chronic  underfeeding  will  sap  the  vital  forces;  the  powers  of  resist- 
ance of  the  body  will  be  so  undermined  that  infection  will  be  easily  con- 
tracted and  underfed  people  will  be  a  danger  to  their  fellowmen  inasmuch 
as  they  will  ]>rovide  a  fertile  agency  for  the  spread  of  infection. 

Its  effects  in  producing  liability  to  disease  were  illustrated  in  a  strik- 
ing way  by  the  outbreaks  of  relapsing  fever  and  typhus  which  followed 


152  OVERFEEDING    AND    UNDERFEEDING 

the  iX)tato  famine  in  Ireland  in  the  early  part  of  the  nineteenth  century. 
Similar  results  have  been  observed  to  follow  in  the  wake  of  famine 
everywhere,  notably  in  India  and  in  China  where  fever  and  plague 
invariably  dog  the  footsteps  of  famine.  It  has  also  been  pointed  out  by 
Hutchison  that  exposure  to  infection  is  specially  apt  to  be  dangerous  on 
an  empty  stomach,  as,  for  example,  before  breakfast,  a  fact  which  it  is 
particularly  important  for  members  of  the  medical  profession  to  bear  in 
mind. 

Enough  has  been  said  as  to  the  relationship  of  underfeeding  to 
disease.  The  two  are  most  intimately  related,  and  it  is  an  obvious  fact' 
that  the  furnishing  of  cheap  and  good  food  is  as  much  of  an  economic 
as  it  is  a  hygienic  measure. 

There  is  one  other  phase  of  the  subject  in  connection  with  individual 
and  public  health  that  is  worthy  of  brief  comment — the  bad  effect  of 
chronic  underfeeding  on  the  digestive  organa.  In  all  cases  of  chronic 
underfeeding  an  impairment  of  organs  concerned  with  the  digestive  pro- 
cess is  observed.  The  truth  of  this  statement  may  be  partly  verified  in 
the  case  of  dyspeptics.  The  less  they  eat  the  less  they  are  able  to  digest 
and  the  more  their  nutrition  fails.  Frequently  the  most  effective  mode 
of  curing  their  stomach  troubles  is  to  insist  that  they  eat  more.  Unfortu- 
nately, so  far  as  the  poor  are  concerned,  this  remedy  is  impossible.  But 
it  is  an  interesting  question  whether  the  effect  of  town  life,  combined 
with  poverty  or  merely  ignorance  or  carelessness  in  impairing  digestive 
])ower,  may  not  be  to  a  certain  extent  responsible  for  the  habitual  under- 
feeding so  often  found  in  the  industrial  section  of  urban  districts.  In 
other  words,  they  may  be  instances  of  both  cause  and  effect.  A  vicious 
circle  has  been  established,  and  the  town  worker  even  when  comparatively 
well-to-do  may  in  many  cases  be  incapable  of  digesting  enough  food  to 
keep  him  in  an  ideal  state  of  physical  efficiency.  This  fact  was  forcibly 
emphasized  in  the  early  part  of  1917  when  the  author  was  mustering 
officers  for  several  National  Guard  regiments,  passing  on  their  fitness 
to  enter  the  Federal  service.  It  was  observed  that  one-third  of  the  young 
men  coming  from  the  industrial  centers  showed  evidences  of  under- 
feeding.    They  were  33  per  cent  undersized,  underfed  and  underweight. 

Diverging  somewhat  from  the  subject  in  hand,  may  not  underfeeding 
also  be  a  potent  cause  of  drinking?  The  underfed  man,  even  if  he  be 
poor,  feels  the  want  of  some  stimulating  or  perhaps  narcotic  action  and 
he  seeks  and  finds  this  spur  or  Lethe  in  alcohol.  There  is  a  definite 
relationship  between  underfeeding  and  the  consumption  of  alcohol. 

Undoubtedly  there  is  a  close  connection  between  underfeeding  and 


u:n^derfeeding  153 

crhne.  The  iiiitlerfed  individual,  especially  if  he  or  she  has  been  under- 
fed from  childhood  up,  is  a  potential  criminal.  Again  it  may  be  said 
that  there  is  no  intention  to  aver  that  lack  of  food  is  the  sole  cause  of 
crime,  but,  on  the  other  hand,  it  is  an  always  present  spur  to  crime. 
Poverty  and  underfeeding  are  debasing  influences,  morally,  physically 
and  mentally,  and  in  the  words  of  Dr.  King  Chambers  (13),  "deficient 
diet,  like  all  morbid  conditions,  both  corporeal  and  mental,  is  a  vitiating 
and  degenerating  influence.  Famine  is  naturally  the  mother  of  crimes 
and  vices,  not  only  of  such  sort  as  will  satiate  the  gnawing  desire  for  food, 
but  of  general  violence  and  lawlessness,  ill  temper,  avarice,  lust  and 
cruelty." 

Underfeeding  if  not  tlie  mother  of  crime  is  at  least  a  very  near  rela- 
tion, and  if  a  nation  is  to  be  happy  and  prosperous  it  is  a  paramount 
necessity  that  its  members  shall  be  well  fed.  Ignorance  has  much  to 
do  w'ith  underfeeding,  and  in  order  to  inculcate  into  the  minds  of  the 
mass  of  the  people  some  elementary  truths  concerning  food  values,  a 
campaign  of  education  should  be  inaugurated  on  these  lines  in  every 
civilized  country.  This  has  been  done  in  the  large  industrial  centers  of 
Great  Britain  and  in  some  of  the  European  countries.  The  Mothers' 
Welfare  Associations,  which  have  sprung  up  throughout  the  urban  com- 
munities of  Great  T^)ritain,  due  to  the  initiative  of  Dr.  Eric  Pritchard  of 
London,  teach  mothers  how  to  feed  and  bring  up  their  babies  and  also 
how  to  feed  and  bring  up  their  families,  including  their  husbands.  With 
regard  to  food  values,  absolutely  exact  and  definite  knowledge  is  still 
lacking,  but  quite  enough  is  known  to  enable  us  to  lay  down  rules  as 
to  the  most  nutritious  and  suitable  foods  for  all  sorts  and  conditions  of 
men  living  in  all  sorts  of  conditions  and  in  any  climate. 

Metabolism  of  Underfeeding — Some  of  the  recent  views  dealing  with 
the  metalx)]ism  of  underfeeding  will  now  be  presented. 

PROTEIN  METABOLISM. — Minimum  Protein  Necessary  to  Maintain 
Nitrogen  Equilibrium. — Views  as  to  protein  metabolism  are  conflicting, 
especially  with  regard  to  the  question  of  how  much  protein  is  necessary 
to  maintain  health,  or,  in  other  words,  to  maintain  nitrogen  equilibrium. 
The  <)})iiiions  of  von  Noorden  and  Rechenberg  on  this  much  vexed  point 
liav(^  been  stated,  and  the  following  (taken  from  von  Noorden)  is  a  table 
in  which  certain  experiments  iu  this  direction  are  noted: 


154 


OVERFEEDING   AND    UNDERFEEDING 


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a  bo 
S3  a> 


03 


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03   fl 

■5= 
a  s-^ 


Q  -P  H  .S     '-1 


Pi 


2.SS 


o 
IS 
O 


o 


00  00  >0  lO  GC 


00    COOO  O 
i-H  CO 


CO  00  00  CO  lO 


00  kC  «0  05 
lO  Ol  O  1— I 

OOOOi-i       1-5       OO     '  rA 


ooo^o 


lO  »o  i>-  »o  1 


CO  00  00  <N  lO 


00  00  CO  •*  iO 


(N        OOOt^iO 
»0        >0  •^  Tf  ■^ 


CO 
(N  T"  '-'  O  t>^ 

^  Tft  "^  Tt^   CO 


O  O  OiiO  (M 
(N  (M  »0  --1  CO 
O  O  iC  t^  TtH 
iC  iOTt<  (N  CO 


SO(N  CO 
T— I  CO  CO 
t^  t^  -^  00 
CO(M  CO(M 


1>  1^00  Oi  Q 
l:^(N  (N  lO  O 
TjH  O  t^  CO  -^ 
(N  CO(N  <N  i-H 


O  OOO"* 


O  O00(N  »0 


00    o  iCt^  CO  t^ 
■^  _g  t^  lO  t>.  lO 


p 

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GO 

03 

o 


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a 


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rt 


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W     Oh   OWW 


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C 

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tl* 

-  S 

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OCO 

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co»o 


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CO  lO 


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=»  fee 

u 
^  CO  t-.  X  o  p  N 

ao  I  I  I  M  T 

_c  ic  cr  t-,  oc  c:  >-i 
Vi  o  6  c  ©  d  «* 


O 


UNDERFEEDING  155 

Von  Noorden  hedges  somewhat  with  regard  to  the  intake  of  protein 
necessary  to  maintain  health  and  the  nitrogen  eqnilibrium  by  giving,  as 
his  opinion,  that  in  spite  of  the  teaching  of  Chittenden  and  others  their 
doctrines  will  not  attract  too  many  admirers,  nor  will  these  doctrines 
bring  them  many  adherents,  for  the  majority  of  men  even  with  the  allnr- 
ing  prospect  of  a  prolongation  of  life  or  rejuvenation  prefer  to  enjoy  the 
comforts  of  this  mundane  sojourn. 

The  workman  will  still  take  a  larger  quantity  of  meat  than  the 
sedentary  man.  More  protein  is  always  taken  during  severe  muscular 
work,  and  there  must  be  a  good  reason  for  this.  The  Vienna  scientist 
then  proceeds  to  dissect  the  explanation  brought  forward  by  Voit  and 
finishes  by  saying  that  while  it  is  certainly  true  that,  in  passing  to  a  diet 
poor  in  protein,  the  body  loses  nitrogen  at  the  outset,  nevertheless  the 
total  loss  is  small,  and  the  functional  capabilities  may  not  be  at  all 
diminished.  If  the  musculature  is  kept  in  good  condition  by  continual 
exercise,  even  if  the  diet  is  lowered  to  less  than  two-thirds  of  Voit's 
standard,  muscular  strength  and  power  of  carrying  out  work  may  be 
actually  increased.  Von  Noorden  may  be,  therefore,  taken  as  an  advo- 
cate of  a  low  protein  intake. 

E.  T.  Spriggs(14),  the  British  authority,  who  has  given  the  question 
of  diet  the  most  thorough  experimental  study,  sums  up  the  relation  of 
protein  to  activity  by  saying  that  the  bulk  of  the  caloric  value  required 
for  muscular  work  should  be  supplied  by  carbohydrate  or  fat,  but  that  it 
is  an  advantage  also  to  increase  the  protein  in  food,  and  that  a  diet  con- 
taining a  fair  amount  of  protein  is  likely  to  be  favorable  to  an  energetic 
existence. 

Another  English  authority,  Sir  James  Crichton  Browne(15),  has 
])ointed  out  that  even  if  it  should  be  fully  established  by  experiments 
more  extended  and  varied  than  those  of  Chittenden,  that  nitrogen 
equilibrium  can  be  maintained  on  a  much  smaller  amount  of  protein  than 
has  hitherto  been  supposed,  there  would  still  be  a  question  as  to  whether 
it  would  be  wise  and  prudent  to  adopt  the  minimum  amount  as  the  rule 
of  life.  With  a  low  protein  supply  the  organism  may  have  to  adapt  itself 
to  its  situation  under  conditions  of  strain.  It  has  a  large  power  of 
adapting  itself  to  circumstances,  but  that  power  may  be  overtaxed.  Let 
it  be  granted  that  the  average  amount  of  protein  food  now  habitually 
ingested  does  considerably  exceed  the  quantity  required  to  maintain  at 
an  exact  point  metabolic  equilibrium,  it  does  not  follow  that  it  should  be 
lowered  to  the  point  at  which,  according  to  laboratory  observations, 
metabolic  equilibrium   stands   steady.      Metabolic  equilibrium    is   never 


156  OVERFEEDING    AND    UNDERFEEDING 

steady  or  at  a  fixed  poiut.  It  varies  in  different  individuals  and  in  the 
same  individuals  from  hour  to  hour,  and  it  is  always  safe  to  allow  a 
margin,  and  a  broad  margin. 

This  writer  contends  that  not  only  is  protein  starvation  manifested 
in  diminished  resistance  to  bacterial  invasion,  but  in  a  general  lowering 
of  bodily  tone,  and  in  debility  which  may  be  traced  to  diminished  metab- 
olism, owing  to  the  withdrawal  of  the  stimulus  to  it  which  alimentary 
principles  of  the  protein  class  supply.  Benedict  (16),  too,  traverses 
Chittenden's  results  and  concludes  that  permanent  reductions  of  protein 
intake  are  decidedly  disadvantageous,  and  not  without  possible  danger. 
The  relationship  of  a  small  protein  intake,  then,  to  underfeeding  has 
been  by  no  means  made  clear.  Some  assert  and  seem  to  have  proved 
their  assertion  by  careful  experiments  that  a  low  protein  intake  has  little 
to  do  with  underfeeding.  At  least  they  state  that  a  man  can  thrive  and 
jjerform  really  hard  labor  on  a  diet  the  protein  constituent  of  which 
would  have  been  regarded  only  a  few  years  ago  as  ridiculously  inadequate. 
Others  hold  that,  while  most  people  were  and  are  accustomed  to  ingest 
too  much  protein,  the  standard  laid  down  by  Chittenden  and  those  who 
hold  his  views  is  too  low.  Still  others,  like  Sir  J.  Crichton  Browne, 
claim  that  a  very  considerable  protein  intake  is  necessary  for  the  conser- 
vation of  good  health,  and  especially  in  the  case  of  laborers  and  those  who 
take  a  good  deal  of  heavy  exercise. 

The  author  is  among  those  who  are  not  extremists  and  is  of  the 
opinion  that  a  fair  amount  of  protein  should  be  taken  by  persons  who  per- 
form manual  labor  and  carry  on  their  work  in  the  open  air.  Therefore, 
a  small  protein  intake  is  a  factor  of  some  moment  so  far  as  underfeeding 
is  concerned.  Underfeeding  in  the  ordinary  circumstances  of  life  occurs, 
as  a  rule,  from  an  insufficiency  of  nitrogen-free  substances,  generally 
associated  with  a  diminution  of  protein. 

In  all  cases  in  which  underfeeding  is  persisted  in  for  long  periods, 
it  is  associated  with  a  smaller  or  greater  loss  of  protein.  Hirschfield  (17), 
Kumagawa(18),  R.  O.  Neumann (19). 

Neumann  supplies  the  best  example  commencing  with  an  insufficient 
diet.  He  very  gradually  raised  the  protein  and  energy  intake  until  he 
arrived  at  nitrogen  equilibrium.  For  thirty-five  days  or  longer  he  kept 
on  the  insufficient  diet. 

The  following  table,  taken  from  von  Noorden,  showed  the  conditions 
that  existed: 


UNDERFEEDING 


157 


TABLE  SHOWING  EFFIX^T  OF  INSUFFICIENT  DIET  WITH  GRADUAL 
INCREASE  IN  ALIMENT  UNTIL  NITROGEN  EQUILIBRIUM  WAS 

ESTABLISHED 


Dura- 
tion in 

Intake 

Cal. 
per 

Nitrogen  Balance 

Differ- 

Weight 

at 
Outset, 
Kilo. 

Sekies 

ence  in 

Days 

N 

Pro- 

Cal. 

Kg. 

Daily 

Of  the  Whole 

Weight 

tein 

Series 

1 

10 

8.02 

51 

1,535 

23 

-2.81 

-28.1 

-hO.O 

67.0 

2 

12 

9.07 

57 

1,599 

24 

-3.11 

-37.3 

-0.9 

67.0 

3 

8 

11.24 

70 

1,909 

29 

-2.11 

-16.9   -96.1 

-0.1 

-1.5 

66.1 

4 

5 

12.70 

79 

1,937 

30 

-2.76 

-13.8 

-0.5 

66.0 

5 

15 

12.23 

76 

2,659 

40 

+0.22 

+  3.3 

+  1.3 

65.5 

66.8 

Aver- 

50 

10.56 

1,987 

30 

-92.8       (!) 

-0.2     (!) 

66.1 

age 

The  striking  fact  to  be  gathered  from  Neuiiiaiiirs  ex})eriiiieuts  is  that 
ill  the  fifty  days,  with  an  average  intake  of  10.50  grams  nitrogen  and 
1,987  calories,  he  lost  93  grams  nitrogen,  and  at  the  same  time  showed 
a  loss  of  only  2  kilograms  in  body  weight. 

The  next  table  shows  a  series  of  experiments  exhibiting  the  different 
amounts  of  protein  requisite  for  the  organism,  as  well  as  for  the  energy 
intake.  G.  Renvall(20),  the  results  of  whose  experiments  are  here  given, 
had  a  different  end  in  view  from  Neumann,  but  used  the  same  methods 
to  carry  out  his  experiments.     His  experiment  was  also  of  long  duration : 

TABLE  SHOWING  EFFECT  OF  INSUFFICIENT  DIET  GRADUALLY  IN- 
CREASED UNTIL  BROUGHT  UP  TO  BODY  REQUIREMENTS » 


Intake 

NitrogenBalance 

Dura- 

Differ- 
ence in 

Series 

Weight 

tion  in 

N 

Cal. 

Cal. 

Daily 

Of  the 

Weight, 

Kg. 

Days 

per  Kg. 

Whole 

Series 

Kg. 

1 

8 

12.1 

2,062 

29 

-5.34 

-42.7 

-1.5 

7L1 

2 

7 

13.7 

2,617 

37 

-2.66 

-18.6 

-2.0 

69.6 

3 

6 

16.1 

2,843 

42 

-2.74 

-16.4 

-0.4 

67.6 

4 

5 

22.7 

3,783 

56 

0.14 

0.7 

-0.0 

67.2 

5 

3 

21.2 

3,577 

53 

-2.47 

-14.8 

-0.0 

67.2 
67.2 

Average 

32 

16.5 

2,889 

46.2 

-2.9 

-91.8 

-3.9 

68.2 

1  Taken  from  von  Noordon. 


158  OVERFEEDING   AND    U:NDERFEEDING 

Neumann  and  lienvall  each  lost  about  92  to  93  grams  nitrogen  in 
five  to  seven  weeks,  the  former  on  a  diet  Avhich  would  be  considered  barely 
sufficient  under  most  circumstances,  the  latter  upon  one  which  would  cer- 
tainly be  regarded  as  rich,  and  yet  the  former  maintained  his  weight 
almost  unaltered.  According  to  von  Noorden,  he  must  have  stored  water, 
because  in  his  opinion  he  could  not  have  stored  before  the  beginning  of 
the  experiment  quantities  of  intracellular  protein  to  account  for  so  slight 
a  loss  of  weight.    Renvall  lost  flesh,  some  water  and  probably  fat. 

In  the  table  on  the  opposite  page  (taken  from  von  Noorden)  are  in- 
cluded other  series  of  experiments. 

All  the  experiments  noted  in  the  above  table  were  carried  out  on  the 
investigators  themselves,  who  were  working  under  practically  identical 
conditions.  The  difference  in  the  amount  of  nitrogen  and  in  the  protein 
and  energy  intake  necessary  to  maintain  equilibrium  is  remarkable  and 
goes  to  show  how  greatly  such  variable  results  are  due  to  the  individual 
organism. 

Chemical  Decomposition  of  Protein  Tissue. — It  used  to  be  the  almost 
invariable  custom  to  regard  every  sign  of  protein  breaking  down  in 
disease  as  dangerous,  and  protein  decomposition  in  the  tissues  as  the 
origin  of  all  grave  sympfoms.  As  a  matter  of  fact,  protein  breaking  down 
in  disease  is  still  looked  upon  as  menacing.  Von  Noorden,  however, 
thinks  that  in  many  cases  this  is  a  false  conception.  He  is  also  of  the 
opinion  that  the  significance  which  is  often  attached  to  the  products  of 
the  chemical  decomposition  of  tissue  protein  is  erroneous.  There  is  no 
space  to  deal  with  the  German  authority's  arguments  against  these  long 
held  beliefs,  and  it  will  be  sufficient  to  say  that  in  his  opinion  the  strongest 
evidence  against  the  doctrine  that  protein  losses  constitute  a  grave  menace 
in  disease  is  that  in  the  most  perfect  health  tissue  protein  breaks  down. 

Pathology  of  Metabolism  of  Starvation. — It  is  very  evident  that  a  knowl- 
edge of  the  metabolism  during  fasting  is  of  the  first  importance  from  the 
outlook  of  physiology  and  pathology.  Experiments  upon  fasting  animals 
and  men  have  brought  out  many  momentous  facts,  while  pathology  has 
to  do  with  diseased  persons  who  are  starving  or  nearly  so.  There  are 
two  kinds  of  fasting:  acute  starvation  and  chronic  starvation  or  mal- 
nutrition. The  former  type  has  been  most  extensively  studied,  but  the 
pathology  of  its  metabolism  is  still  incomplete. 

To  deal  with  the  pathology  of  metabolism  of  starvation  or  chronic 
malnutrition  exhaustively  would  take  more  space  than  can  be  given  to  it 
in  this  work.  Nor,  perhaps,  would  much  be  gained  by  so  doing,  since 
opinions  on  some  of  the  more  important  points  have  not  crystallized,  and 


UNDERFEEDING 


159 


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160 


OVERFEEDIJs^G   AXD    UXDERFEEDING 


experiments  on  chronic  malnutrition  have  been  inadequate  for  many 
obvious  reasons.  The  object  of  this  treatise  will  be  to  discuss  some  of 
the  more  salient  points  in  regard  to  the  subject. 

As  to  the  consumption  of  energy  on  the  complete  withdrawal  of  food 
during  the  first  days,  according  to  most  authorities,  the  general  metab- 
olism suffers  no  diminution.  The  sum  of  the  investigations  gathered 
from  experiments  on  fasting  men  give  general  values  of  22  to  25  calories 
per  kilogram  per  day  as  the  mean  minimum  conversion  of  energy  while 
fasting  during  complete  bodily  rest.  The  expenditure  of  energy  during 
starvation  diminished  in  the  same  proportion  as  the  weight  of  the  body. 
The  fasting  man  lives  upon  protein  and  fat,  except  during  the  first  few 
days,  while  his  muscles  and  liver  still  contain  glycogen.  The  respiratory 
quotient  at  times  fell  below  the  theoretical  minimum  0.7. 

Pembrey  and  Spriggs(21)  record  that  in  rats,  during  fasting,  the 
respiratory  exchange  quickly  reaches  a  minimum,  and  remains  almost 
constant  during  the  prolongation  of  the  fast. 

CONSUMPTION  OF  ENERGY  IN  CHRONIC  MALNUTRITION.— With  regard 
to  consumption  of  energy  in  chronic  malnutrition,  experiments  are  few 
and  inconclusive.  It  seems  that  certain  individuals  are  able  to  exist 
with  a  particularly  low  consumption  of  energy.  Von  Noorden  believes 
that  even  in  chronic  malnutrition,  the  minimum  amount  of  energy 
required  by  persons  who  are  bedridden  or  who  are  indoors  and  do  little 
bodily  work  does  not  fall  below  30  to  32  calories  per  day  per  kilogram. 

The  following  are  Rubner's  figures  for  a  dog  whose  consumption  of 
energy  was  investigated  for  three  years : 

TABLE  SHOWING   DIMINISHING   CONVERSION   OF  CALORIES   PER 
KILOGRAM  ACCOMPANYING  PROGRESSIVE  LOSS  OF  FLESH 


Variations  in 

Weight, 

Kilogram 

Mean  Weight, 
Kilogram 

Average  Conver- 
sion of  Calories 

Average  Conver- 
sion of  Calories 
per  Kilogram 

8.01-6.84 
6.66-6.33 
6.27-5.80 

6.94 
6.45 
6.09 

432.1 
371.8 
332.0 

62.3 
57.6 
54.7 

PROTEIN  METABOLISM  IN  ACUTE  STARVATION.— The  protein  metab- 
olism of  man  during  acute  starvation  has  often  been  investigated. 
Fasting  persons  habitually  drink  water  in  small  quantities.  After  the 
first  day,  or  perhaps  after  the  first  two  days,  the  standard  loss  of  nitrogen 


UNDERFEEDING  161 

may  be  taken  as  10  to  lo  grains  for  the  next  week  or  ten  days.  The  loss 
of  nitrogen  according  to  Pransintz(22)  is  relatively  greater  in  the  thin 
than  in  the  fat.  The  nitrogen  excretion  of  fasting  women  is  from  20 
to  30  per  cent  less  than  that  of  fasting  men.  The  protein  decomposition 
is  relatively  large  at  first,  and  usually  sinks  somewhat  sharply  as  the 
starvation  proceeds. 

Figures  show  how  the  organism  spares  its  protein  when  it  is  ill  fed. 
Chronic  malnutrition  is  not  characterized  by  a  small  nitrogen  excretion, 
but  the  output  of  nitrogen  depends  essentially  upon  the  preceding  diet. 
In  chronic  malnutrition  but  little  urinary  nitrogen  is  usually  found. 
Von  Noorden  is  not  an  advocate  of  protein  feeding  and  claims  that  pro- 
tein cannot  prevent  tlie  loss  of  power  in  underfed  people  and  he  concludes 
that  in  heat-value  starvation  a  protein-rich  diet  does  not  protect  the  tissue 
protein  from  being  consumed.  According  to  von  Noorden  our  present 
knowledge  of  the  decomposition  of  protein  in  chronic  underfeeding  is  as 
follows : 

1.  After  prolonged  malnutrition  the  decomposition  of  protein  is  gi'ad- 
ually  lessened ;  more  of  the  tissue  protein  is  lost  in  the  earlier  than  in  the 
later  stages.  Analogous  are  cases  where  the  demand  for  heat  is  met  fully 
while  only  the  protein  intake  fails  to  reach  the  required  level.  Loss  of 
the  body  protein  does  not  necessarily  follow  in  such  cases.  Nitrogen, 
equilibrium  can  be  maintained  upon  a  protein  decomposition  far  smaller 
than  that  which  usually  obtains,  as,  for  instance,  on  a  daily  excretion  of 
from  6  to  10  grams  of  nitrogen  in  the  urine  and  feces.  But  generally  it 
is  only  weak  persons  who  illustrate  this  possibility,  and  the  question 
may  properly  be  asked  whether  a  larger  protein  intake  would  not  bring 
them  more  nearly  to  their  optimum  of  nutrition  and  strength. 

2.  Long  continued  underfeeding,  apart,  perhaps,  from  minute  and 
hitherto  unproven  degrees  of  caloric  deficiency,  invariably  leads  to  loss 
of  body  fat  as  well  as  to  loss  of  tissue  protein,  whether  the  supply  of 
food  protein  is  large  or  small.  Only  the  absolute  extent  of  nitrogen 
excreted  varies  with  the  latter  factor;  the  establishment  of  a  nitrogen 
balance  is  independent  of  its  duration.  A  diet  of  low  heat  value  but  rich 
in  protein  can  diminish,  or  even  for  a  time  postpone,  the  loss  of  nitrogen, 
but  in  the  long  run  the  result  for  human  beings  will  be  the  same  as  if 
all  the  components  of  the  diet  were  diminished.  If  the  heat  value  of  the 
food  be  continuously  inadequate,  an  increase  of  protein  will  perhaps  put 
a  stop  to  the  loss  of  nitrogen  from  the  body  for  the  time  being,  but,  in 
man,  a  moment  comes  when  further  increase  of  the  food  protein  in  the 
diet  becomes  impracticable.     In  these  circumstances  the  tissue  protein 


162  OVERFEEDING    AXD    U:N^DERFEEDIJ^G 

can  only  be  maintained  by  adding  nitrogen-free  constituents  to  the  diet 
in  order  to  satisfy  the  demand  for  heat. 

3.  At  present  no  exact  quantitative  measurements  of  the  relations 
between  the  caloric  deficit  and  the  loss  of  body  protein  in  chronic  under- 
feeding are  extant.  The  loss  is  unexpectedly  small  in  some  cases,  in 
others  surprisingly  large. 

4.  Whenever  a  poorly  nourished  individual  receives  an  increased 
amount  of  food,  so  that  the  deficiency  of  heat  is  decreased,  an  eifort  is 
made  to  retain  nitrogen  and  repair  the  loss  of  cellular  material  that  has 
occurred.  This  retention  of  nitrogen  goes  on  until  the  body  has 
readjusted  itself  to  its  new  conditions  of  nutrition.  Then  the  loss  of 
nitrogen  begins  anew  unless  the  calories  required  have  been  adequately 
supplied.  The  influence  of  starvation  or  chronic  malnutrition  upon  the 
digestive  organs  is  that  their  activity  is  lowered  although  not  uniformly. 
Malnutrition  leading  to  extreme  loss  of  body  weight  does  not  invariably 
stop  the  production  of  hydrocliloric  acid. 

SECRETION  OF  BILE.— There  is  less  secretion  of  bile  during  fasting 
than  when  the  diet  is  full,  but  it  is  never  entirely  absent.  The  quantity 
of  bile  secreted  is  diminished  but  it  is  usually  more  concentrated.  The 
glycogen  in  the  liver  is  consumed  rapidly,  at  first,  but  more  slowly  as  the 
fasting  continues.  F.  Muller(23)  found  that  during  starvation  the 
feces  contained  hardly  any  soluble  protein,  but  a  relatively  large  propor- 
tion of  nuclein.  The  excretion  of  fat  amounted  to  1.21,  0.57,  and  1.14 
grams  a  day.  About  half  consisted  of  neutral  fats  and  cholesterin,  the 
other  half  being  composed  of  free  fatty  acids  and  soaps.  The  absorbing 
power  of  the  intestine,  according  to  many  German  authorities,  does  not 
diminish  in  consequence  of  prolonged  malnutrition.  This  is  an  important 
])oint  with  regard  to  dietetic  treatment  in  connection  with  the  evacuation 
of  feces.  A  certain  amount  of  putrefaction  is  said,  to  go  on  in  the 
intestine  during  the  withdrawal  of  food  despite  the  fact  that  no  protein 
reaches  the  intestine. 

THE  BLOOD.— In  chronic  malnutrition  the  percentage  of  water  in  the 
blood  is  maintained  approximately  at  the  n.ormal  level. 

During  starvation  the  leukocytes  are  diminished  in  number. 

THE  URINE. — During  starvation  the  average  amount  of  urine  remains 
sub-normal.  In  cases  of  chronic  underfeeding  the  conditions  vary  greatly 
so  that  no  fixed  rules  can  be  laid  down. 

During  acute  starvation  protein  is  often  found  in  the  urine,  though 
mostly  in  minute  quantities.  Clinical  experience  shows  that  a  moderate 
degree  of  chronic  underfeeding  does  not  commonly  lead  to  the  appearance 


imDERFEEDIN'G  163 

of  more  albumin  in  the  nrine  than  may  be  present  normally.  The  case  is 
altogether  different  when  marked  and  protracted  malnutrition  is  met 
with.  In  such  instances,  albuminuria,  transient  or  lasting,  is  the  rule. 
Mild  glycosuria  has  been  observed  in  a  few  fasting  experiments  and 
chronic  underfeeding  but  is  probably  not  directly  responsible  for  any 
form  of  diabetes. 

Conclusions — The  above  brief  review  of  the  metabolism  and  patholog- 
ical metabolism  of  starvation  and  chronic  underfeeding  is  necessarily 
incomplete  and  does  not  profess,  as  stated  in  the  introductory  remarks, 
to  do  more  than  give  a  few  of  the  more  important  facts.  From  the 
experimental  aspect  of  underfeeding,  no  very  definite  conclusions  can  be 
drawn,  that  is,  conclusions  of  practical  value.  Among  those  who  have 
studied  the  matter  in  laboratories  somewhat  wide  difference  of  opinion 
exists  with  regard  to  important  points.  Animal  experimentation  is 
fallacious,  or  at  any  rate  not  to  be  entirely  depended  upon  in  drawing 
conclusions  applicable  to  man.  Experiments  on  those  in  a  condition  of 
chronic  underfeeding  are  few  and  far  between  except  in  cases  of  disease, 
in  which  conditions  are  not  analogous.  Fasting  experiments  are  valuable, 
but  a  person  fasting  is  not  in  the  same  condition  as  one  who  is  chronically 
underfed  and  consequently  experiments  as  to  metabolism  on  fasting  per- 
sons are  not  wholly  reliable. 

It  is  true  that  the  application  of  the  experimental  method  has  yielded 
and  will  yield,  as  science  progresses,  some  insight  into  the  general  prin- 
ciples which  govern  the  nutrition  of  the  body. 

Upon  food  depends  not  only  life  itself,  but  the  power  to  work  and 
to  resist  disease.  An  ill-fed  people  are  a  backward  people,  and  an 
unhealthy  and  a  degenerate  people.  From  the  vegetable  world  innumer- 
able examples  can  be  gathered  to  illustrate  the  great  effect  of  food 
variations  upon  growth  and  development.  In  a  good  soil  a  plant  will 
evolve  in  a  marvelous  manner.  On  the  other  hand,  a  bad  soil  will  yield 
a  poor  growth.  Tlie  most  striking  example  of  the  effect  of  food  upon 
development  in  the  animal  world  is  afforded  by  the  queen  bee,  which 
grows  from  a  larva  in  all  respects  similarly  to  the  working  bee,  but  owes 
her  superior  growth  to  the  fact  that,  different  from  the  rank  and  fi.le  of 
the  bee  tribe,  she  is  assiduously  fed  on  a  rich  diet. 

There  are  two  or  three  points  which  the  author  desires  to  emphasize 
with  regard  to  underfeeding.  The  first  is  that  chronic  underfeeding  is 
prevalent  even  in  this  country  and  that  it  is  more  due  to  ignorance  than 
to  poverty.  The  poor  do  not  know  anytliing  about  food  values  and,  more 
often  than  not,  buy  foods  which  constitute  not  only   a  comparatively 


164  OVEKFEEDTXG    A:N"D    TT:N'DERFEEDIN'G 

iiiiiiitritious    but    an    ill-balaiiceJ    diet.      Education    is    needed    in    this 
direction. 

Another  point  is  that  scientific  experiments  cannot  wholly  determine 
food  values.  In  the  experience  of  mankind  with  regard  to  diet,  there 
are  spread  out  before  us  the  results  of  the  experiments  of  ages,  and  we 
must  be  quite  as  greatly  influenced  by  such  experiments  as  by  laboratory 
investigations.  The  experiments  of  ages  have  demonstrated  that  man 
can  live  a  healthy  life  under  dietetic  conditions  of  great  variety.  It  is 
not  wise  to  be  bound  by  the  teachings  of  one  system  or  another.  By 
studying  in  an  open-minded  manner  the  teachings  of  experience  together 
with  the  results  of  scientific  experiments,  we  shall  be  able  to  formulate 
dietaries  suitable  for  conditions  of  health  and  disease.  It  is  with  these 
principles  that  the  problem  of  underfeeding  should  be  met. 


EEFEEENCES 

1.  Thompson,  Sir  Henry.    Food  and  Feeding,  p.  64. 

2.  ZuNTZ.     Sind  Kalorisch  Aquivalente  Mengen  von  Kohlenhydraten 

und  Fetten  fiir  Mast  und  Gutfettung  Gleichwertig  ?     Theraj). 
d.  Gengenw.,  1901. 

3.  RuBNKR.     Gesetze  des  Energieverbranches,  1902. 

4.  VON  NooRDEN.     Pathology  of  Metabolism. 
f).     Howell.     Handbook  of  Physiology,  1915. 

6.  RosENFELD.     Ergebuisse  der  Physiologic,  1902,  vol.  i,  part  i. 

7.  ZuNTz,  ScHUMBiTRG,  U.     Phjs.  dcs  Marschcs,  1901. 

8.  Krat^s.      von    Noorden's    Pathology    of    Metabolism,    Fever    and 

Infection. 

9.  SvENsoN.      Stoffwechselversuche   an   Rekonvaleszenten,   Zeitsch.    f. 

klin.  Medi.,  1901. 

10.  HiTTCiiisoN.     Food  and  Dietetics. 

11.  Rechenberg.     Ernahrung  der  Ilandwiber,  1890. 

12.  Flint.     Physiology  of  Man,  New  York,  1867,  p.  35. 

13.  Chambers,  King.     Manual  of  Diet  in  Health  and  Diseases,  1876, 

2nd  ed.,  p.  223. 

14.  Spriggs,  E.  T.     Sutherland's  System  of  Diet  and  Dietetics. 

15.  Browne,  Sir  James  Crichton.     Parsimony  in  Nutrition. 

16.  Benedict.    Am.  J.  Physiol.,  1906,  p.  409. 

17.  Hirsciifieli),  F.     Zur  Ernahrungslehre  d.  Mensch.,  Arch.  f.  path. 

anat.  u.  Physiol.,  114,  301,  1889. 


REFERE:N"CES  165 

18.  KuMAGAWA.      Ernahr.    mit    geniischt.    u.    rein    vegetabilis — Rost. 

Arch.  f.  path.  anat.  ii.  Physiol.,  116,  370,  1889. 

19.  Neumann.     Taglich  Eiweissbedarf  des  Menchen,   Arch.   f.   Heil- 

kunde,  45,  1,  1903. 

20.  Renvall,  G.     Und  Nig-Umsatz  beim  erwachsenen  Mensch.,  Skan- 

dovischer  Archiv.  fal  Physiol.,  16,  94,  1904,  p.  101. 

21.  Pembrey  and  Spriggs.    Metabolism  in  Fasting  and  Feeding,  Jour, 

Physiol.,  vol.  31,  p.  343,  1904. 

22.  Pransintz  .     Zur    Eiweissersetziing    des    hungernden    Menschen, 

Mlinch.  med.  Wchnsehr.,  1891,  p.  319. 

23.  MuLLER,  F.    T^ntersnchiingen  an  zwei  hungernden  Menschen,  Arch. 

f.  path.  anat.  u.  Physiol.,  131,  suppl.,  1893. 


Ill 


CHAPTER   VII 


PROTEIN   AND    NUTRITION 

The  discovery  of  a  new  dish  does  more  for  the  happiness  of  humankind  than 
the  discovery  of  a  new  star, 

Nature   of   Protfiii;    Tlie  Protein  Poison. 

Metabolism  cf  Protein:  Deaminization  of  Proteins  in  Amino- Acids;  Catab- 
olism  of  Proteins. 

Effect  of  Protein  Diet  on  Health  and  Endurance:  High  Protein  Diet; 
Low  Protein  Diet;  Chittenden's  Investigations,  Fisher's  Investiga- 
tions, liaeltz's  fnvestigatious  among  Japanese,  Other  Foreign  Nations 
Non-Meat  Eaters. 

Standard  of  Protein  Requirement  in  Dietary. 

High  versus  Low  Protein  Diet:  Protein  Diet  and  the  Nitrogen  Equilibrium; 
Reduction  of  Protein  Diet  Necessary;  Effect  of  Increased  Nitrogen 
Diet  on  the  Kidneys;  Effect  of  Protein  Diet  on  Strength  and  Endur- 
ance; Effect  of  Low  Protein  Diet  on  Animals;  Protein  Diet  and 
Occupation;  The  Amino- Acid  in  Animal  and  Vegetable  Proteins; 
Minimum  Protein  Requirement  to  Maintain  Nitrogen  Equilibrium; 
Safety  Standard  in  Diet:  Caution  as  to  Protein  Deficiency,  Overfeed- 
ing, Underfeeding,  Ill-Eifects  of  Absorption  of  End-Products  of  Pro- 
tein Digestion. 

Protein  Structure  and  Properties:  Chemical  Formation  of  the  Protein 
Fractions;  Quantitative  Differences  of  Proteins,  Qualitative  Varia- 
tions in  the  Amino-Acids  of  Proteins;  Physical  Properties  of  Proteins; 
Relative  Absorption  of  Proteins;  Differences  in  Suitability  for  Tissue 
Construction. 

Theories  of  Protein  Metabolism. 

Nature  of  Protein — During  the  past  few  years  a  revolution  has  taken 
place  in  our  conception  of  protein  metabolism,  and  we  should  all  be 
proud  of  the  fact  that  our  own  coimtrv  has  furnished  its  full  quota  of 
newly  discovered  facts  upon  which  our  present  knowledge  is  based. 

While  studying  the  physiology  of  digestion  (see  Volume  I,  Chapter 
VTI),  we  learned  that,  among  the  building  material  employed  for  the 
construction  of  the  living  organism,  the  proteins  hold  a  place  apart,  and 
we  also  learned  that  protein  is  absorbed  only  after  being  largely  or  com- 
pletely broken  down  in  amino-acids,  which  are  then  rebuilt  into  the 
protein  organism. 

167 


168  PKOTEIX    AKD    NUTRITION 

The  coiiceptiou  of  the  structure  of  a  protein  molecule  is  of  special 
importance  not  only  in  the  study  of  protein  metabolism,  for  which  we 
are  to  use  it  here,  but  also  in  enabling  us  to  grasp  the  almost  unthinkable 
varieties  in  which  protein  exists,  without  there  being,  in  many  instances, 
any  outward  chemical  reaction  or  physical  property  by  which  one  protein 
can  be  distinguished  from  another.  It  is  interesting  to  note,  however, 
that  differences  in  structure  which  are  too  slight  to  be  recognizable  by 
any  ordinary  chemical  tests  may  become  very  apparent  upon  minute 
biological  examination  when  we  proceed  to  observe  the  behavior  of  an 
animal  into  whose  blood  some  of  the  protein  is  directly  injected.  It  is  a 
well-known  fact  that  symptoms  of  varying  severity  develop,  from  the 
almost  instantaneous  death  produced  by  snake  venom  to  the  slowly 
developing  anaphylactic  reactions  which  follow  the  injections  into  the 
blood  of  many  proteins  that  are  chemically  indistinguishable  from  those 
of  the  blood  itself. 

The  Protein  Poison  (Protein  Absorption). — ^Vaughan  and  Wheeler  in 
1903  found  that  the  cellular  substance  of  the  colon  bacillus(l)  contains 
a  highly  active  poison  and  that  a  closely  related  or  similar  poison  could 
be  obtained  from  other  pathogenic  and  non-pathogenic  bacteria  and  from 
vegetable  and  animal  proteins.  It  is  not  found  in  gelatin.  The  symp- 
toms induced  by  this  poison  in  guinea  pigs  are,  first,  peripheral  irrita- 
tion, such  as  an  urticarial  rash ;  second  stage,  partial  paralysis,  with 
rapid  and  shallow  breathing,  and,  third  or'  convulsive  stage,  that  which 
begins  as  isolated  clonic  movements  and  finally  becomes  general,  involv- 
ing all  the  muscles  of  the  body;  with  fatal  doses  there  is  a  progressive 
fall  of  temperature.  Kemp (2)  points  out  that  small  doses  administered 
subcutaneously  in  animals  produce  fever  and  that  various  types  of  fever 
may  be  stimiilated  by  varying  the  size  of  the  dose  and  the  intervals  of 
administration.  When  proteins  are  acted  on  by  the  digestive  juices,  the 
product  becomes  poisonous  at  the  peptone  stage,  and  if  it  were  so 
absorbed  into  the  circulation,  it  would  be  highly  injurious,  but  with  nor- 
mal digestion .  the  peptone  is  broken  up  into  harmless  amino-acids.  If 
proteins,  however,  enter  the  blood  without  being  properly  changed  by 
the  action  of  the  digestive  juices,  then  they  must  be  digested  in  the 
blood  and  tissues  (parenteral  digestion),  and  during  the  process  the 
protein  poison  is  set  free  and  exerts  its  deleterious  effects  on  the  body. 
It  is  suspected  by  some  that  protein  has  an  influence  in  the  production 
of  the  summer  diarrheas  of  infancy,  and  studies  of  the  protein  poison 
and  protein  sensitization  have  demonstrated  how  the  protein  element  of 
bacteria  influences  the  nature  and  progress  of  the  infectious  diseases. 


METABOLISM    OF    PEOTEIN  169 

Special  idiosyncrasies  to  certain  foods  may  be  explained  on  the  above- 
mentioned  grounds,  as,  for  example,  urticaria,  presenting  the  aspect  of 
anaphylaxis  from  absorption  of  protein.  In  certain  conditions,  at  least, 
protein  absorption  with  parenteral  digestion  is  a  cause  of  protein 
poisoning. 

METABOLISM    OF    PROTEIN 

Deaminization  of  Proteins  in  Amino-Acids — -According  to  E.  E.  Smith, 
who  has  given  the  subject  most  careful  study,  the  simple  amino-acids(3) 
formed  in  the  intestinal  tract  from  protein  breakdown,  so  far  as  we  know, 
are  absorbed  as  such  and  carried  through  the  blood  stream  to  the  various 
tissues  of  the  body,  where  they  meet  their  fate.  They  are  not  absorbed 
with  the  same  readiness,  but  there  is  apparently  a  decided  selective  action, 
both  as  to  the  particular  amino-acids  absorbed  and  as  to  the  quantity. 
When  they  reach  the  tissues  there  is  a  recombination  not  to  form  the 
protein  originally  ingested,  but  rather  to  form  the  proteins  of  the  par- 
ticular tissues.  Protein  resynthesis,  not  in  absorption,  but  by  the  indi- 
vidual tissues  to  which  the  amino-acids  are  brought  by  the  blood  stream, 
must  be  regarded  as  sufficiently  established  to  be  accepted  as  a  working 
hypothesis.  In  this  way  a  certain  portion  of  tlie  absorbed  amino-acids 
is  utilized.  A  certain  other,  and  usually  a  relatively  large,  portion,  not 
needed  for  protein  resynthesis,  undergoes  a  different  change.  Instead 
of  entering  into  constructive  metabolic  processes,  it  undergoes  catabolic 
transformations. 

Catabolism  of  Proteins. — When  proteins  are  introduced  directly  into 
the  blood,  parenterally,  as  we  say,  they  act  as  a  foreign  substance  and 
may  be  eliminated  more  or  less  unchanged  by  the  kidneys,  giving  rise 
to  albuminuria ;  may  pass  into  the  bile,  thereby  reaching  the  intestinal 
tract,  where  they  are  digested;  may  pass  directly  into  the  alimentary 
tract  through  the  intestinal  walls;  or  finally  may  be  split  by  enzymes 
elaborated  by  body  cells. 

Sensitization  to  a  given  protein  is  developed  as  the  result  of  the 
introduction  of  the  protein  into  the  blood  and  is  specific  to  each  protein. 
When  it  has  once  been  developed,  the  subsequent  introduction  of  tlie 
particular  protein  into  the  system  is  followed  by  the  phenomenon  of 
anaphylaxis. 

EFFECT    OF    PROTEIN   DIET    ON    HEALTH    AND    ENDURANCE 

High  Protein  Diet. — In  overfeeding  of  a  particular  protein,  a  condi- 
tion may  be  produced  that  is  entirely  similar  to  the  protein  sensitization 


170  PROTEIN    AND    NUTRITION 

that  follows  the  introduction  of  protein  parenterally.  Perhaps  this  has 
been  most  clearly  observed  in  the  forced  feeding  of  eggs,  especially  to 
the  young,  though  it  ig  not  uncommonly  seen  with  a  paTticular  forai  of 
fish  feeding,  notably  shellfish.  Frequently,  too,  this  has  been  observed 
with  meats,  and  least  commonly  with  vegetable  proteins,  presumably 
because  of  the  less  concentrated  form  of  the  latter  and  their  slower 
transformation  into  soluble  protein  in  digestion,  though  in  individual 
instances  particular  vegetable  proteins  have  produced  the  condition  to  a 
marked  degree.  Probably  few  physicians  have  failed  to  recognize  at 
least  some  of  the  more  marked  cases  of  this  kind,  aiid  probably  few  have 
often  failed  to  overlook  most  of  the  less  marked  cases. 

Following  an  instance  or  period  of  overfeeding,  there  appears  a  con- 
dition of  intolerance  to  the  protein  in  question,  which  is  manifest  when 
the  particular  protein  is  again  ingested  by  certain  rapidly  developing 
symptoms,  perhaps  the  most  constant  of  which  is  an  urticaria,  apt  to  be 
generalized  in  extent  with  intense  itching,  frequently  dyspnea,  sometimes 
muscular  incoordination  and  often  symptoms  of  gastro-intestinal  irrita- 
tion. It  is  probable  that  angioneurotic  edema  is  in  some  instances,  at 
least,  a  manifestation  of  protein  sensitization.  It  is  a  question  for  con- 
sideration to  what  extent  active  protein  is  the  absorbed  material  and  to 
what  extent  the  protein  is  absorbed  as  proteose.  Where  the  urine 
shows  the  elimination  of  unchanged  protein,  we  may  well  believe  that 
the  offending  material  is  native  protein;  and  where  the  urine  is  found 
to  contain  the  foreign  protein  as  proteose,  we  must  at  least  give  serious 
consideration  to  the  possibility  of  the  protein  having  been  absorbed  as 
proteose,  though  even  there  it  must  be  recognized  that  the  native  protein 
may  have  been  transformed  into  protein  after  absorption,  since  it  is  the 
tendency  of  the  tissues  to  bring  about  this  change. 

We  may  well  question  whether  urticaria  following  food  ingestion  is 
always  to  be  regarded  as  an  anaphylactic  manifestation  or  whether  it  is 
not  at  times  produced  by  a  different  type  of  gastro-intestinal  toxemia. 
When,  for  example,  we  regard  the  toxemia  following  the  ingestion  of 
strawberries,  we  have  a  condition  well  explained  from  most  points  of 
view  by  the  theory  of  protein  sensitization ;  but  we  have  to  face  the  fact 
that  strawberries  are  not  rich  in  protein  and  that,  therefore,  the  sensi- 
tization, if  present,  has  been  produced  without  rich  protein  ingestion. 
Evidently  some  further  knowledge  is  required  before  the  pathology  of 
susceptibility  to  strawberries  can  be  unequivocally  regarded  as  coming 
within  this  category. 

Recently,  the  theory  of  protein  sensitization  has  attracted  attention 


EFFECT    OF    PROTEIN    DIET  171 

and  in  some  instances  is  charged  with  the  faults  that  have  heretofore 
been  explained  by  chronic  intestinal  toxemia  of  bacterial  origin.  It  is 
a  matter  for  the  future  to  decide  to  what  extent  toxic  manifestations  are 
to  be  referred  to  the  absorption  of  proteins,  to  products  of  bacterial 
synthesis  of  the  digestive  products  of  food  proteins.  At  the  present  time 
the  evidence  already  at  hand  as  to  the  part  played  by  bacterial  decompo- 
sition is  not  to  be  ignored  (4). 

Low  Protein  Diet — CHITTENDEN'S  INVESTIGATIONS.— Prof.  Chitten- 
den, of  Yale  University,  in  November,  1902,  began  an  experiment  upon 
himself  which  he  has  recorded.  At  this  time  he  was  forty-seven  years 
of  age  and  weighed  143  pounds(5).  He  says  that,  accustomed  to  eating 
daily  an  amount  of  food  approximately  equal  to  the  prevailing  dietary 
standards,  he  recognized  that  his  habits  of  living  should  not  be  too  suddenly 
changed,  so  a  gradual  reduction  was  brought  about  in  the  amount  of  pro- 
tein or  albuminous  foods  he  was  accustomed  to  ingest.  Within  the  course 
of  a  month  or  two  this  gradual  decrease  in  proteins  reached  complete  abo- 
lition of  breakfast,  except  for  a  small  cup  of  coffee.  A  light  lunch  was 
partaken  of  at  the  noon  hour,  followed  by  a  heavier  dinner  in  the  early 
evening.  Occasionally,  however,  the  heartier  meal  was  partaken  of  at 
the  noon  hour,  as  his  appetite  suggested.  It  should  be  added  that  the 
total  intake  of  food  was  gradually  diminished,  as  well  as  the  protein 
constituents.  There  was  not,  however,  a  change  to  a  vegetable  diet,  but 
a  simple  introduction  of  physiological  economy.  The  goal  to  which  his 
attention  was  directed  was  the  exclusion  of  meat  in  some  measure,  the 
appetite  not  calling  for  this  form  of  food  in  the  same  degree  as  formerly. 

At  the  beginning,  he  confesses  that  this  change  to  a  smaller  amount 
of  food  daily  was  attended  with  some  discomfort,  but  gradually  passed 
away,  and  his  interest  in  the  subject  was  increased  by  the  discovery  that 
he  was  uncjuestionably  in  improved  physical  condition.  A  rheumatic 
trouble  in  the  knee  joint,  which  had  persisted  for  a  year  and  a  half,  and  ^ 
which  only  partially  responded  to  treatment,  entirely  disappeared.  Minor 
troubles,  such  as  sick  headaches  and  bilious  attacks,  no  longer  annoyed 
him  periodically,  as  in  the  past.  He  experienced  greater  appreciation 
of  such  food  as  was  eaten  and  possessed  a  keener  appetite.  A  more  acute 
taste  appeared  to  be  developed  and  a  more  thorough  liking  for  simple 
foods.  According  to  his  report,  by  June,  1903,  his  body  weight  had 
fallen  to  about  128  pounds. 

In  speaking  further  of  his  experience,  Ire  says  that  during  this  sum- 
mer the  same  simple  diet  was  adhered  to:  a  small  cup  of  coffee  for 
breakfast,  a  fairly  substantial  dinner  at  midday,  and  a  light  supper  at 


172  PKOTEi:^    AND    NUTKITION 

night.  The  next  two  months  he  spent  at  a  iishing  resort  in  northern 
Maine.  Part  of  the  time  he  dispensed  with  a  guide  and  rowed  his  own 
boat,  frequently  six  to  ten  miles  in  the  forenoon  (against  head  winds), 
without  breakfast,  and  with  much  greater  freedom  from  fatigue  and 
muscular  soreness  than  previously  on  a  fuller  protein  dietary.  On  his 
return  home  he  weighed  127  pounds.  From  July  1st  he  remained  con- 
stantly at  this  point,  at  which  it  would  seem  that  the  body  had  found 
and  maintained  its  equilibrium.  In  order  to  determine  his  nitrogen 
equilibrium,  he  collected  each  day's  output  of  urine  for  a  period  of  eight 
and  a  half  months.  The  urine  was  analyzed  every  day  and  the  contained 
amounts  of  nitrogen,  uric  acid  and  phosphoric  acid  recorded. 

The  daily  average  was  as  follows:  from  October  13,  1903,  to  March 
12,  1004,  the  average  volume  of  urine  excreted  was  468  grams;  the 
nitrogen  content  was  5. GO  grams;  uric  acid,  0.302  gram,  and  phosphoric 
acid,  0.004  gram.  It  will  be  observed  that  the  volume  of  urine  excreted 
was  small,  though  fairly  constant  for  the  whole  period.  The  explana- 
tion offered  is  that  on  a  low  intake  of  protein  there  is  less  thirst  and 
less  desire  to  drink.  When  nitrogenous  waste  is  reduced  to  a  minimum 
there  is  no  need  on  the  part  of  the  body  for  any  large  amount  of  fluid  to 
flush  out  the  kidneys,  while  with  heavier  eating — partaking  of  highly 
nitrogenous  foods — an  abundance  of  water  is  necessary  to  prevent  the 
kidneys  from  becoming  clogged,  thereby  explaining  the  frequent  bene- 
ficial results  of  the  copious  drinking  of  mineral  waters,  spring  waters, 
etc.,  frequently  called  for  after  or  with  heavy  eating.  It  is  obvious, 
therefore,  that  a  small  volume  of  urine  each  day  means  so  much  less 
wear  and  tear  of  the  delicate  mechanism  of  the  kidneys.  The  low  nitro- 
gen output  of  only  5.60  grams,  equal  to  35.56  grams  of  decomposed 
protein,  is  very  remarkable.  Prof.  Chittenden  afiirms  that  there  could 
be  little  doubt  that  his  body  was  in  nitrogen  equilibrium  and  that  his 
body  weight  was  constant  during  the  whole  period.  Chittenden,  in  sum- 
ming up  his  observations,  says (6)  : 

Health,  strength,  mental  and  physical  vigor,  have  been  maintained  unimpaired, 
and  there  is  a  growing  conviction  that  in  many  ways  there  is  a  distinct  improve- 
ment in  both  the  physical  and  mental  condition.  Greater  freedom  from  fatigue, 
greater  aptitude  for  work,  greater  freedom  from  minor  ailments,  have  gradually 
become  associated  to  the  writer's  mind  with  this  lowered  protein  metabolism  and 
general  condition  of  physiological  economy. 

Chittenden  was  fully  alive  to  the  necessity  of  caution  in  the  accept- 
ance of  his  feelings  as  a  measure  of  physical  or  mental  condition,  but  he 
was  keenly  watchful  for  any  sign  or  svmptom  during  the  course  of  his 


EFFECT    OF    PKOTEIN    DIET 


173 


experiments,  and  is  still  strongly  of  tiie  opinion  that  there  is  much  good 
to  be  gained  in  the  adoption  of  dietetic  habits  that  accord  more  closely 
with  the  true  physiological  needs  of  the  body.     Thus  he  asks: 

If  a  man  of  154  pounds  body  weight  can  maintain  a  condition  of  equilibrium 
with  continuance  of  health,  strengtli  and  vigor  (to  say  nothing  of  possible  im- 
provement) with  a  daily  consumption  of,  say,  60  grams  of  protein  food,  and  suffi- 
cient non-nitrogenous  food  to  yield  2,800  calories,  why  should  he  load  up  his 
system  each  day  with  twice  this  amount  of  protein  food,  with  enough  fats  and 
carbohydrates  to  yield  3,500  calories  plus? 

The  result  of  Chittenden's  researches  demonstrates  that  the  protein 
intake  must  be  a  little  in  excess  of  protein  catabolism,  as  all  of  the  pro- 
tein is  not  available  and  as  this  is  a  variable  amount,  depending  on  the 
proportion  of  animal  and  vegetable  foods  to  their  different  degrees  of 
digestibility  and  availability,  (^iiittenden  formulates  the  following  table, 
showing  the  amount  of  food  necessary  to  yield  60  grams  of  protein: 

CHITTENDEN'S  TABLE 


Variety  op  Foods 


Protein  Content 

60  grams 

60 

u 

60 

u 

60 

u 

60 

u 

60 

u 

60 

u 

60 

u 

60 

« 

60 

« 

60 

u 

60 

u 

60 

u 

60 

u 

60 

u 

60 

u 

60 

u 

60 

u 

60 

a 

60 

u 

60 

a 

60 

« 

60 

« 

60 

a 

60 

u 

60 

u 

60 

u 

60 

u 

Fuel  Value 
in  Calories 


14  lb.  fresh  lean  beef  (loin) .  .  .  . 

9  hens'  eggs 

f,  lb.  sweetbread 

^4  lb.  fresh  liver 

1  lb.  lean  smoked  bacon 

%  lb.  halii)ut  steak 

14  lb.  salt  codfish  (boneless) .  .  . 

2  I  lbs.  oysters,  solid 

V2  lb.  American  pale  cheese. .  . . 
4  lbs.  (2  quarts)  of  whole  milk . . 

Vf,  lb.  uncooked  oatmeal 

V/i  lbs.  shredded  wheat 

1  lb.  uncooked  macaroni 

1  i-  lbs.  white  wheat  bread.  .  .  . 

I  i4   lbs.  crackers 

1%  lbs.  flaked  rice 

-|-  lb.  dried  beans 

V/i  lb?,  baked  beans 

}4  lb.  dried  peas 

l\i  lbs.  potato  chips 

j  3  lb.  almonds 

|-  lb.  pine-nuts,  pignolias 

1%  lbs.  peanuts 

10  lbs.  bananas  (edible  portion) 
10  lbs.  grapes 

I I  lbs.  lettuce       

15  lbs.  prunes 

33  lbs.  apples 


308 

720 

660 

432 

1,820 

423 

245 

506 

1,027 

1,300 

1,550 

2,125 

1,665 

1,520 

2,381 

2,807 

963 

1,125 

827 

5,728 

2,020 

1,138 

3,584 

4,600 

4,500 

990 

5,550 

9,570 


174  PROTEIN    AND    NUTRITION 

Value  of  Meats  as  a  Source  of  Nitrogen. — Chittenden,  in  discussing 
''the  value  of  meat  as  food,"  after  declaring  that  protein  food  is  the 
supply  of  nitrogen  needed  for  the  body,  asks  the  question,  "What  advan- 
tages do  meats  possess  as  a  source  of  this  nitrogen?"  His  answer  v/as: 
"Meats  represent  a  concentrated  form  of  protein,  their  nitrogen  is  readily 
available,  they  are  easily  digestible,  they  have  an  agreeable  flavor,  they 
add  variety  to  the  diet,  they  contain  extractives  which  have  an  exhila- 
rating and  stimulating  effect,  they  satisfy  the  pangs  of  hunger  more 
completely  and  for  a  longer  period  than  do  the  vegetable  proteins. 

"There  can  be  no  question  but  that  meats  occupy  a  somewhat  peculiar 
place  in  the  category  of  dietetic  articles.  A  close  study,  of  the  dietetic 
customs  of  civilized  people  indicates  that  two  distinct  objects  are  ever 
kept  clearly  in  view,  viz. :  the  satisfying  of  the  grosser  needs  of  the  body, 
the  needs  of  general  nutrition,  and  the  satisfying  of  the  needs  of  the 
higher  functions  of  the  central  nervous  system.  Meats  plainly  share 
with  foods  derived  from  the  vegetable  kingdom  the  ability  to  minister 
to  the  former  wants  of  the  body,  but  in  addition  they  have  certain  stimu- 
lating properties  which  distinguish  them  from  the  grosser  vegetable  foods. 
They  might  also  in  this  respect  be  classed,  perhaps,  with  such  articles  as 
tea,  coffee,  etc.,  in  their  power  of  ministering  to  the  wants  of  the  brain 
and  nervous  system.  Sir  William  Roberts  has  well  said  that  the  strug- 
gle for  existence,  or  rather  for  a  higher  and  better  existence,  among 
civilized  men,  is  almost  exclusively  a  brain  struggle;  and  that  these 
brain  foods,  as  they  have  been  not  inappropriately  termed,  must  be 
regarded  as  a  very  important  part  of  the  equipment  for  that  struggle, 
for  if  we  compare,  with  our  limited  information,  the  general  charac- 
teristics of  the  high-fed  and  the  low-fed  classes  and  races,  we  would  no 
doubt  perceive  a  broad  distinction  between  them.  In  regard  to  bodily 
strength  and  longevity,  the  difference  is  inconsiderable,  but  in  regard  to 
mental  qualities,  the  distinction  is  most  marked.  The  high-fed  classes 
and  races  display,  on  the  whole,  a  richer  vitality,  more  momentum  and 
individuality  of  character  and  a  greater  brain  power  than  their  low-fed 
brethren,  and  they  constitute  a  soil  or  breeding  ground  out  of  which 
eminent  men  arise." 

FISHER'S  INVESTIGATIONS.— ]^rof.  In'ing  Fisher,  a  co-worker  of 
Chittenden's  at  Yale  University,  has  conducted  some  interesting  experi- 
ments emphasizing  the  effect  of  diet  on  endurance (Y).  In  arranging 
the  tests,  a  large  variety  of  food  and  dishes  commonly  prepared  in  that 
locality  was  supplied,  and  the  subjects  were  particularly  enjoined  to 
masticate  thoroughly  and  even  to  keep  liquid  foods  in  the  mouth  until 


EFFECT    OF    PROTEIN    DIET 


175 


well  insalivated  and  to  swallow  only  in  response  to  almost  compulsory 
inclination.  The  subjects  for  this  experiment  were  nine  in  number  and 
the  experiment  lasted  four  and  a  half  months.  The  diet  supplied  at  the 
beginning  contained  28  grams  of  protein  and  had  a  fuel  value  of  2,830 
calories.  "The  subjects  were  informed  as  to  the  protein  content  of  the 
various  articles  of  food  and  were  requested  to  eat  those  foods  poor  in 
protein  so  long  as  the  appetite  evinced  no  disinclination  to  them.  The 
exercises  carried  out  as  tests  of  physical  endurance  were  as  follows" : 

1.  Rising  on  the  toes  as  many  times  as  possible. 

2.  Deep  knee  bending  as  many  times  as  possible. 

3.  Raising  the  legs  from  the  floor  to  a  vertical  position  as  many  times 
as  possible  while  lying  flat  upon  the  back. 

The  following  table  will  graphically  present  the  mathematical  result 
of  these  experiments: 

FISHER'S   TEST   DIET   AND   ENDURANCE 


Calories 

Protein 

Strength 
Per  cent 

Endur- 
ance 

Weight, 
Kilos 

Total 

Per  cent 

Gr. 

Per  cent 

At  the  beginning. . 
After  23/2  months . 
After  4]^  months . 

2,830 
2,670 
2,220 

100 
94 

78 

98 
82 
51 

100 
80 
52 

100 

104 

93 

100 
133 
189 

68.2 
67.3 
65.5 

Fisher's  experimental  findings  are  somewhat  opposed  to  those  of 
Chittenden.  Chittenden's  experiments  evidenced  an  increase  in  strength ; 
in  the  Fisher  experiments  it  was  endurance  of  the  men  which  attracted 
attention  and  with  proof  that  endurance  was  increased,  while  their 
strength  varied  very  little  either  way. 

Fisher  carried  out  some  comparative  endurance  tests  between  sixteen 
meat  eaters  (students  from  Yale  University)  and  thirty-two  vegetarians 
connected  with  the  Battle  Creek  Sanitarium.  The  latter  had  been  vege- 
tarians from  four  to  twenty  years.  They  not  only  abstained  from  meat, 
but  also  from  coffee,  tea  and  condiments,  and  they  were  also  teetotalers 
and  non-smokers.     The  endurance  tests  were  as  follows: 

1.  Squatting  on  the  heels  and  rising  thence  to  upright  position  as 
many  times  as  possible. 

2.  Holding  out  the  arms  fully  extended  for  as  long  a  time  as  possible. 

The  results  are  shown  in  the  following  table: 


176  PROTEIX    AND    KUTRITIOK 

FISHER'S   COMPARATIVE   ENDURANCE   TESTS 


Meat  Eaters 


Vegetarians 


Percentage  of 
Difference 


Knee  bendings 

Holding  arms  out  (minutes) 


383 
10 


846 
49 


121% 
390% 


According  to  the  result  tabulated  above,  the  standard  of  meat  eaters 
is  shown  as  100,  while  the  endurance  of  the  vegetarians  is  from  121  to 
390,  and  we  may  therefore  draw  the  conclusion  that  strength  and  endur- 
ance have  nothing  to  do  with  the  consumption  of  generous  quantities 
of  protein,  as  was  formerly  a  matter  of  faith.  Furthermore,  it  is  an 
admitted  fact  that  great  endurance  is  possible  on  simple  food  of  low 
protein  value,  in  support  of  which  we  may  cite  the  example  of  the 
Japanese  and  Arabs. 

BAELTZ'S  INVESTIGATIONS  AMONG  THE  JAPANESE.— Professor  Baeltz,^ 
a  keen  observer  and  one  of  the  best  authorities  on  the  Japanese  country 
and  people,  says  -  that  the  people  of  the  lower  classes  in  Japan  who 
subsist  almost  entirely  on  carbohydrate  foods  are  altogether  of  more 
powerful  build  than  those  of  the  upper  classes  who  eat  meat.  It  is  well 
known  to  students  of  dietetics  that  the  Japanese  for  some  thousand  years 
past  have  been  experimenting  with  vegetable  and  cereal  foods,  and  at 
the  present  time  the  diet  upon  which  the  bulk  of  the  Japanese  people 
subsist  is  sufficient  for  the  maintenance  of  an  effective  nitrogen  equi- 
librium, as  well  as  to  keep  them  in  a  state  of  efficient  nutrition.  Pro- 
fessor Baeltz  had  two  jinrikisha  men  in  his  employ,  both  powerful  young 
fellows,  aged  twenty-two  and  twenty-five  respectively,  who  had  followed 
their  calling  for  years.  They  were  provided  with  an  accurate  amount 
of  measured  food,  the  chemical  composition  of  which  was  ascertained  by 
recognized  men.  These  men  received  definite  instructions:  Every  day 
for  three  weeks  their  duty  was  to  drag  a  jinrikisha  with  Professor 
Baeltz,  who  weighed  170  pounds,  a  distance  of  twenty-five  miles,  run- 
ning all  the  time.  This  would  seem  to  be  an  arduous  task,  but  not  more 
so  than  these  men  would  willingly  and  readily  undertake.  It  would  be 
considered  quite  an  undertaking  to  walk  a  distance  of  twenty-five  miles 
every  day  for  three  weeks  with  an  August  sun  at  its  best,  but  for  these 

1  Baeltz  was,  for  some  years,  body-physician  to  the  late  Mikado. 

2  Quoted  by  Dr.  Albn  in  "Die  Vegetarische  Diilt."  Tt  should  be  observed  that 
Dr.  Albn  writes  against  vegetarianism,  but  concedes  that  one  may  subsist  on  vegetarian 
diet,  which   is  proved  among  other  things  by  Baeltz's  observations. 


EFFECT    OF    PROTEIN    DIET  177 

men  to  run  this  distance  every  day,  and  to  drag  a  jinrikislia  with  a 
passenger  weighing  176  pounds,  is  rather  more  than  one  would  usually 
expect. 

During  this  experiment  the  men  kept  to  their  usual  diet,  which  con- 
sisted of  fats  amounting  to  less  than  the  proposed  standard  enunciated 
by  Voit(8),  while  the  contained  protein  fluctuated  from  between  60  to 
80  per  cent  of  his  postulate.  Carbohydrates  were  provided  in  exceed- 
ingly large  quantities  in  the  form  of  rice,  potatoes,  barley,  chestnuts, 
lily  roots  and  other  foodstuffs  peculiar  to  the  country.  The  men  were 
weighed.  One  had  gained  half  a  pound  and  the  other  was  the  same  as 
at  the  beginning.  Professor  Baeltz  now  told  the  men  that  they  would 
be  allowed  a  liberal  allowance  of  meat,  which  quite  delighted  them,  as 
meat  to  them  was  a  luxury.  The  carbohydrate  ration  was  cut  down  and 
a  jjroportionate  quantity  of  meat — not  quite  as  much  protein  as  the  Voit 
standard,  but  a  considerable  amount — was  allowed.  The  men  ate  with 
avidity,  but  after  three  days  on  the  meat  diet  they  importuned  Professor 
Baeltz  to  discontinue  the  meat  and  to  give  it  to  them  only  upon  con- 
clusion of  their  probation,  because  they  felt  fatig"ued  and  could  not  run 
so  well  as  they  did  previous  to  taking  meat.  Baeltz  then  allowed  them 
to  return  to  their  original  carbohydrate  dietary,  with  the  same  result  as 
before — the  one  retained  his  weight,  with  perhaps  a  difference  of  100 
grams,  and  the  other  gained  about  half  a  pouiid. 

Baeltz  records  an  even  greater  feat  of  endurance  on  a  smaller  diet. 
Baeltz  was  driving  from  Tokio  to  Nikko,  a  distance  of  about  sixty-eight 
and  a  half  miles.  It  was  midsummer  and  fearfully  hot,  and  it  took 
Baeltz  from  six  o'clock  in  the  evening  until  eight  o'clock  the  following 
morning — fourteen  hours — to  make  the  distance.  He  says  that,  just  as 
he  was  driving  out  of  Tokio,  he  saw  a  Japanese  sitting  in  a  jinrikisha 
and  asked  him  where  he  was  going.  Nikko  was  likewise  his  destination 
and  he  was  being  pulled  along  by  a  man.  He  arrived  in  Nikko  just  half 
an  hour  after  Baeltz.  Baeltz  records  that  his  driver  had  changed  horses 
six  times,  and  this  Japanese  jinrikisha  man  had  dragged  his  compatriot, 
an  adult  weighing  119  pounds,  a  distance  of  sixty-eight  and  a  half  miles 
at  a  running  pace  in  about  fourteen  and  a  half  hours,  and  on  a  vegetable 
diet  only. 

It  is  well  known  that  the  Japanese  are  physically  a  small  people,  yet 
they  are  capable  of  remarkable  feats  of  strength  and  endurance,  and  as 
recent  events  have  shown,  they  are  full  of  courage  and  daring.  A 
writer (0)  in  the  British  Medical  Journal  says:  "The  Japanese  them- 
selves attribute  their  high  average  of  physical  strength  to  a  plain  and 


178  PROTEIN    AND    NUTKITION 

frugal  diet,  and  to  a  system  of  g;yTnuastics,  jiu-jitsu,  which  includes  a 
knowledge  of  anatomy,  and  of  the  internal  and  external  use  of  water. 
In  1889  a  commission  was  appointed  to  consider  whether  by  a  meat 
diet  or  by  other  means  the  stature  of  the  Japanese  race  could  be  raised; 
but  the  conchision  arrived  at  was  that,  seeing  that  their  feats  of  strength 
and  powers  of  endurance  were  superior  to  races  mucli  taller  than  them- 
selves, the  lowness  of  their  stature  did  not  matter.  Concerning  the  diet, 
they  are  frugal  to  a  degree,  partaking  of  rice  at  every  meal.  Japanese 
troops  have  often  made  record  marches  on  diet  consisting  solely  of  a 
little  rice.  Vegetables  and  fruits  are  grown  in  abundance  in  Japan, 
and  their  value  as  a  regular  part  of  the  dietary  is  realized  with  far  more 
advantage  than  it  is  in  this  country.  Indeed,  a  laborer  is  content  to 
work  a  whole  day  on  a  dinner  of  tomatoes  and  cucumbers.  Milk  is 
scarce,  because  it  does  not  pay  to  raise  cows  to  produce  milk  alone,  and 
the  meat  is  not  eaten." 

Ol'HKR  FOREIGN  NATIONS  NON-MEAT  EATERS.— According  to  Sin- 
clair,^ the  Hindu  pattamars,  carriers  of  dispatches,  who  eat  only  rice, 
run  every  day,  passing  from  one  town  to  another,  twenty  leagues  at 
least,  and  continue  thus  for  weeks.  Russian  agriculturists,  who  live  on 
vegetables,  black  bread,  milk  and  garlic,  work  sixteen  to  eighteen  hours 
per  day,  and  their  strength  is  said  often  to  exceed  that  of  the  American 
sailors  (10).  The  Norwegian  peasants  scarcely  know  of  animal  ali- 
mentation ;  they  cover,  however,  whilst  accompanying  the  carriages  of 
tourists,  from  three  to  four  leagues,  running  without  stopping.  Modern 
Egyptian  workmen  and  boatmen,  who  from  time  immemorial  have  fed 
almost  exclusively  on  melons,  onions,  broad  beans,  lentils,  dates  and 
maize,  have  remarkable  muscular  strength  (11).  The  miners  of  South 
America,  very  sober  workmen,  who  do  not  eat  meat,  carry  on  their  shoul- 
ders weights  of  200  pounds,  with  which  they  mount  twelve  times  a  day, 
on  an  average,  vertical  ladders  60  to  80  meters  high (12).  According 
to  H.  Ranke,  the  woodcutters  of  Upper  Bavaria  feed  almost  exclusively 
on  flour  (1,100  to  1,200  grams  per  day)  cooked  with  hogs'  lard  (90 
gi'ams)^  without  eggs  or  cheese;  on  Sundays  only  they  have  a  little  pork. 
They  do,  however,  an  enormous  amount  of  work (13).  The  Turkish 
soldier  is  extraordinarily  abstemious;  he  drinks  only  water  or  lemonade, 
feeds  on  pillauf  of  rice  and  figs  and  scarcely  touches  meat.  We  know 
that  his  vigor  is  remarkable  and  his  courage  indomitable. 

We  might  learn  a  great  deal  from  the  Arabs  with  respect  to  those 

1  We  extract  the  majority  of  the  following  facts  from  the  interesting  work  of 
Mrs.  A.  Kingsford   (Theses  de  Paris,  1880). 


EFFECT    OF    PUOTKIX    DIET  179 

diseases  wliicli  result  from  excessive  meat  eating.  The  French  and 
Italians  have  long  ago  experienced  the  greatest  difficulty  in  their  attempts 
to  subdue  this  brave  and  energetic  people.  They  are  of  slender  build,  but 
their  powers  of  endurance  are  remarkable.  According  to  Auzimour(14) : 
"They  are  slim  and  wiry  people;  their  limbs  are  lithe  and  strong;  their 
profile  is  more  curved  than  straight.  They  live  in  tents  which  are  far 
from  sanitary.  The  frugality  of  the  Arabs  is  just  as  far  famed  as  that 
of  the  camel.  Men  often  go  on  long  journeys  into  the  desert  with  only 
a  bag  of  meal,  some  tigs,  a  skin  of  water  and  some  dates.  With  the  meal 
the  Arab  makes  his  cakes,  which,  with  his  dates,  are  his  provision  for 
the  day.  They  are  hardy  and  resist  disease."  Dr.  Auzimour  says,  "Ab- 
dominal wounds,  with  perforation  of  the  intestines,  heal  without  the 
use  of  antiseptics  when  the  injured  parts  have  been  replaced.  Wounds 
healing  under  such  circumstances  and  without  consequent  blood  poison- 
ing are  a  source  of  wonder  to  surgeons  acquainted  only  with  Euro- 
peans. Diseases  of  nutrition  are  almost  unknown  among  them;  ulcers 
and  cancer  of  the  stomach  are  very  seldom  met  with,  and  if  one  comes 
across  a  case  of  summer  diarrhea,  it  is  generally  because  the  sufferer  has 
been  eating  too  many  melons.  Appendicitis  is  very  rare  among  the 
Arabs,  and  is  entirely  unknown  among  the  vegetarian  nomads."  The 
experience  of  Dr.  Auzimour  is  that  Arabs  who  live  in  towns  and  who 
eat  as  Europeans  do  are  no  more  resistant  to  these  diseases  than  the 
Europeans.  We  are  convinced  that  common  stomach  troubles  and  intes- 
tinal disorders  quite  often  arise  from  fermentation  caused  by  putrefying 
animal  protein,  as  these  complaints  disappear  like  dew  under  the  morn- 
ing sun  on  a  low  protein  diet. 

Professor  Maurel,  of  Toulouse,  who  served  for  thirty  years  as  army 
surgeon  in  the  French  colonies,  while  in  the  tropics  made  experiments 
in  nutrition  in  consequence  of  which  he  has  come  to  the  conclusion 
that  most  of  the  so-called  tropical  diseases  are  caused  through  overeating, 
and  particularly  through  excessive  meat  eating.  In  his  work  on  nutri- 
tion (15)  he  arrives  at  the  following  conclusions: 

1.  "That  the  majority  of  digestive  disorders  (dyspepsia,  diarrhea, 
dysentery)  which  are  so  common  in  the  tropics  are  partly  to  be  ascribed 
to  hypernutrition." 

2.  "That  overindulgence  in  animal  foods  is  largely  the  cause  of  the 
liver  disorders  met  with  in  the  tropics." 

3.  "That,  finally,  the  increased  richness  of  blood,  which  is  due  to  the 
absorption  of  too  large  a  quantity  of  food,  particularly  protein  food — 


180  PROTEIX    AND    NUTRITION 

which  he  has  termed  hyperuutritioii — constitutes  a  contributory  cause  of 
the  fevers  so  prevalent  in  our  colonies." 

STANDARD   FOR   PROTEIN   REQUIREMENT   IN   DIETARY 

In  attempting  to  formulate  the  standard  for  the  requisite  amount  of 
protein  in  the  dietary,  we  find  no  such  definite  and  satisfactory  basis  for 
judgment  as  in  the  case  of  the  total  energy  or  fuel  value  of  foods.  Indi- 
cations are  lacking  that  any  kind  of  work  necessarily  increases  the 
expenditure  of  fuel,  or  that  the  body  can  store  up  protein  to  anything 
like  the  extent  that  it  stores  up  fuel  in  the  form  of  fat;  the  feeding  of 
protein  above  what  is  required  for  maintenance  and  body  equilibrium 
increases  only  slightly  the  store  of  protein  in  the  human  economy.  When 
one  authority  suggests  an  amount  of  protein  but  little  above  the  mini- 
mum required  for  equilibrium,  and  another  advocates  a  much  higher 
amount,  there  is  implied  a  difference  of  view  regarding  protein  such  as 
no  longer  exists  with  respect  to  the  energy  metabolism.  The  difference, 
it  is  true,  is  hardly  so  great  as  might  appear  from  a  casual  examination 
of  the  proposed  standards (16).  According  to  the  standard  of  Voit, 
Playfair  and  Gautier,  protein  contributes  about  16  per  cent  of  the  fuel 
value  of  food;  Atwater's  experience  suggests  about  15  per  cent;  while 
Langworthy  puts  it  at  12  per  cent  and  Chittenden  as  low  as  S^/o  per  cent. 

Peschel  undertook  a  personal  experiment  to  determine  the  amount 
of  protein  necessary  for  his  own  body;  he  weighed  169  pounds.  He 
was  guided  by  Rubner's  work  in  nutrition  which  he  considered  of  espe- 
cial value,  and  accepted  his  data  as  a  working  basis:  100  grams  of  fat, 
240  grams  of  starch,  249  grams  of  sugar,  770  grams  of  fresh  muscle 
flesh  free  from  fat,  and  that  the  nutrients  could  be  substituted  for  one 
another  for  this  purpose.  Rubner  teaches  that  "growth  is  a  function  of 
a  cell ;  it  can  be  rendered  latent  by  insufficient  protein,  but  protein  can- 
not raise  the  rapidity  of  growth  above  the  level  set  by  nature."  Peschel 
holds  that  a  certain  amount  of  protein  is  necessary  to  repair  the  waste 
of  nitrogenous  tissue  which  is  continually  going  on,  as  well  as  to  make 
up  for  the  loss  of  portions  of  the  epidermis,  hair,  nails,  epithelial  cells, 
etc.  His  investigations  were  undertaken  at  the  suggestion  and  under 
the  direction  of  von  Noorden  to  determine  the  exact  amount  of  protein 
necessary  for  his  body  metabolism.  He  ingested  a  ration  consisting  of 
bread,  rice,  potatoes,  butter,  sugar,  tea,  etc.,  but  no  meat.  The  analysis 
of  his  ration  showed  that  he  was  partaking  of  40  grams  of  protein  in  a 
diet   which   yielded   3,640   calories.      On   the  fifth   day  he  reached   his 


STANDARD  FOR  PROTEIN  REQUIREMENT  IN  DIETARY     181 

iiitrogeuous  equilibriuin,  that  is  to  say,  he  was  ingesting  sufficient  pro- 
tein for  the  needs  of  the  body,  and  the  organism  was  sufficiently  supplied 
with  carbohydrates  and  fats.  He  soon  reduced  the  protein  to  32  grams 
per  day,  the  caloric  value  of  his  ration  then  being  3,600  calories,  but 
the  organism  continued  to  lose  nitrogen  on  a  protein  intake  of  only  32 
grams.  He  therefore  concluded  that  Voit's  standard  for  protein  was  far 
above  the  amount  actually  needed,  provided  the  organism  is  well  sup- 
plied with  fats  and  carbohydrates: 

THE  NITROGEN  REQUIRED  FOR  MAINTENANCE 


Investigator 

Body 

Weight, 

Kilos 

Calories 
per 
Kilo 

Protein 

per  Kilo, 

Grams 

Nitrogen 

in  Food, 

Grams 

Protein 

in  Food, 

Grams 

Chittenden's  physiolog-1 

ical  minimum j 

Voit's  Standard 

Maurel's  Standard 

Peschsel 

70 

70 

70 

77 

1    Varies    1 

jwith  work] 

40 

46 

.50 

1.70 

1.50 

.50 

5.50 

19.10 

16.83 

6.30 

34 

119 

105 

40 

Students  who  have  carried  out  experimental  researches  to  determine 
the  amount  of  nitrogenous  food  necessary  for  body  metabolism  are 
agreed  that  individuals  can  live  for  some  time  with  no  nitrogenous  food, 
and  that  they  can  live  for  a  time  with  no  food  at  all;  but  such  experi- 
ments are  of  no  especial  physiological  value,  other  than  furnishing  evi- 
dence to  determine,  from  the  metabolism  of  nitrogen,  on  a  nitrogen-free 
diet  or  during  starvation,  the  amount  of  protein  needed  daily  to  prevent 
the  disintegration  of  the  body  tissues.  The  observations  of  Chittenden, 
Voit,  Maurel,  Peschel  and  others,  with  which  Tibbies,  who  has  given  this 
subject  much  attention,  is  in  complete  accord,  clearly  demonstrate  that  it 
is  possible  to  maintain  life,  keep  the  body  in  nitrogen  equilibrium  and 
to  do  a  certain  amount  of  work  on  a  diet  having  the  standard  caloric 
value,  but  containing  a  very  much  smaller  amount  of  protein  than  is 
usually  given  in  standard  dietaries. 

Jones  closely  followed  an  investigation  in  the  case  of  Schmehl.  This 
man  walked  500  miles  in  six  days,  or  an  average  of  83i^  miles  per  day, 
and  subsisted  on  a  ration  consisting  of  beefsteak,  eggs,  beef  tea,  cham- 
pagne and  aerated  waters.  Tibbies  says,  "The  severe  and  strenuous 
exertion  caused  an  increased  excretion  of  nitrogen,  phosphoric  acid  and 
sulphuric  acid.  On  the  first  day  of  the  walk,  the  urea  output  amounted 
to  63  grams,  on  the  last  day  to  30  grams,  so  that  the  excretion  gradually 

diminished  during  the  500-mile  walk.     The  fact  should  not  be  lost  sight 
112 


182  PROTEIN    AND    NUTRITION 

of  that  the  diet  influences  the  amount  of  urea  excreted.  A  man  of  ordi- 
nary stature,  in  the  state  of  equilibrium  and  partaking  of  an  ordinary 
mixed  diet,  excretes  daily  from  5  to  40  grams,  or  an  average  of  33  grams 
of  urea.  When  the  diet  is  poor  in  protein,  it  may  drop  to  from  15  to 
20  grams,  but  when  it  is  rich  in  protein,  the  output  may  rise  to  90  or 
100  grams  per  day." 

Atwater  and  Sherman  record  an  investigation  carried  out  upon 
Miller,  who  succeeded  in  riding  2,007  miles  in  six  days  without  showing 
signs  of  physical  or  mental  fatigue  at  the  end  of  the  journey.  Miller 
was  twenty-four  years  old  and  the  fuel  value  of  his  ration  was  50  per 
cent  above  that  of  the  standard  dietaries,  showing  from  169  to  211  grams 
of  protein  daily.  Estimates  were  made  of  the  food  consumed.  The 
urine  and  feces  were  analyzed  and  showed  that  the  protein  metabolized 
in  his  body  was  more  than  that  contained  in  his  food. 

Weston,  the  American  pedestrian,  was  used  for  an  experiment  to 
determine  his  nitrogenous  equilibrium.  He  consumed  more  protein  per 
day  than  Miller.  This  investigation  was  studied  by  Flint  (17)  and 
Pavy(18),  who  arrived  at  different  conclusions  as  to  the  results  in  this 
case.  Flint  avers  that  severe  muscular  exertion  increases  the  excretion 
of  nitrogen. 

The  tables  on  p.  183,  compiled  by  Flint,  show  the  nitrogen  income 
and  outgo  before,  during  and  after  the  walk. 

In  the  study  of  this  subject,  the  tabulated  experiments  of  Atwater(19) 
and  his  associates  are  enlightening.^  These  experiments  were  all  carried 
on  with  the  subject  in  the  respiratory  calorimeter.  The  table  reports 
the  amount  of  food  ingested,  i.e.,  the  sum  total  of  food  available  for  tissue 
building  and  for  the  production  of  energy.  In  addition,  the  table  shows 
the  available  energy  of  the  food  digested,  i.e.,  the  difference  between  the 
total  heat  of  combustion  and  the  heat  of  combustion  of  the  unoxidized 
matter  in  feces  and  urine,  and  also  the  loss  or  gain  of  protein  or  fat 
to  the  body. 

Other  data  shown  are  the  average  daily  amount  of  available  protein 
and  energy  derived  from  the  food,  the  amount  required  by  the  body,  the 
amount  required  by  the  body  when  at  rest,  and  again  when  engaged  in 
vigorous  muscular  work. 

The  dietary  standards  previously  suggested  by  careful  investigators 
have  served  their  purpose,  but  they  must  of  necessity  undergo  various 
changes  as  the  subject  becomes  more  accurately  and  scientifically  studied. 

1  See  Table,  page  184, 


STANUAKU  FOE  PKOTEIN  KEQUIKEMENT  IN  DIETARY    183 

FLINT'S  OBSERVATIONS  ON  THE  EFFECTS  OF  THE  FIVE-DAY  PEDES- 
TRIAN FEAT  PERFORMED  BY  WESTON 

Before  the  Walk 


Weight 

Temper- 

Nitrogen 

Nitrogen 

Excess  or 

of  Body, 

ature, 

PuLse 

Miles 

m 

in 

Deficiency 

Nude, 

Deg. 

Walked 

Ingesta, 

Egesta, 

in  Nitrogen 

Lbs. 

Fahr. 

Grains 

Grains 

Egesta, 
Grains 

First  Day 

120.5 

99.7 

75 

15 

361.22 

323.26 

-  37.96 

Second  Dav..  . . 

121.25 

98.4 

73 

5 

288.35 

301.18 

+  12.83 

Third  Day 

120 

98.0 

71 

5 

272.27 

330.36 

+  58.09 

Fourth  Day..  . . 

118.5 

99.1 

78 

15 

335.01 

300.57 

-  34.44 

Fifth  Day 

119.2 

99.5 

93 

1 

440.43 

320.06 

-120.37 

During  the  Walk 


Weight 

Temper- 

Nitrogen 

Nitrogen 

Excess  or 

of  Body, 

ature, 

Miles 

m 

m 

Deficiency 

Nude, 

Deg. 

Pulse 

Walked 

Ingesta, 

Egesta, 

in  Nitrogen 

Lbs. 

Fahr. 

Grains 

Grains 

Egesta, 
Grains 

First  Dav 

116.5 

95.3 

98 

80 

151.55 

357.10 

+205.55 

Second  Dav..  . . 

116.25 

94.8 

93 

48 

265.92 

370.64 

+  104.72 

Third  Day 

115 

96.6 

109 

92 

228.61 

397.58 

+  168.97 

Fourth  Day..  . . 

114 

96.6 

68 

57 

144.70 

348.53 

+203.83 

Fifth  Day 

115.75 

97.9 

80 

40.5 

383.04 

332.77 

-  50.27 

After  the  Walk 


Weight 

Temper- 

Nitrogen 

Nitrogen 

Excess  or 

of  Body, 

ature, 

Miles 

m 

m 

Deficiency 

Nude, 

Deg. 

Pulse 

Walked 

Ingesta, 

Egesta, 

in  Nitrogen 

Lbs. 

Fahr. 

Grains 

Grains 

Egesta, 
Grains 

First  Day 

118 

98.6 

76 

2 

385.65 

295.70 

-  89.95 

Second  Dav. . . . 

120.25 

98.4 

73 

2 

499.10 

358.81 

-140.29 

Third  Dav 

120.25 

99.3 

70 

2 

394.83 

409.87 

+  15.04 

Fourth  Day. . . . 

123.5 

98.8 

78 

2 

641.71 

382.89 

-258.82 

Fifth  Day 

120.75 

97.5 

76.5 

3 

283.35 

418.49 

+  135.14 

184  PROTEIN    AND    NUTIUTION 

INFLUENCE  OF  WORK  ON  THE  FOOD  REQUIREE  (ATWATER) 


Character  and  Duration 
OF  THE  Experiment 

Nitrogen 
(Grams) 

Carbon 
(Grams) 

Energy 
(Calor.) 

Protein 

(Nx6.25) 
(Grams) 

Fat 

(Grams) 

(a)  Rest  Experiments 
E.  0. :  Eleven  experiments,  aver- 
age of  37  days: 
In  digested  food 

17.7 
18.5 

231.5 
218.6 

2,459 

2,297 

111 
116 

In  material  oxidized 

Gain  (+)  or  loss  (  — )  to 
the  body 

-.8 

+12.9 

-5 

+20 

0.  F.  T. :  One  experiment,  aver- 
age of  5  days: 
In  digested  food 

14.4 
13.7 

216.5 
219.9 

2,442 
2,505 

90 

86 

In  material  oxidized 

Gain  or  loss  to  the  body . 

+.7 

-3.4 

+4 

-7 

A.  W.   S.:  Three  experiments, 
average  of  9  days: 
In  digested  food 

14.7 
13.7 

214.3 

229.1 

2,344 
2,293 

92 

86 

In  material  oxidized 

Gain  or  loss  to  the  body . 

-Kl.O 

-14.8 

+6 

-24 

J.    F.    S.:   Three   experiments, 
average  of  9  days: 
In  digested  food 

15.4 
15.7 

228.7 
207.8 

2,381 
2,117 

96 

98 

In  material  oxidized 

.  Gain  or  loss  to  the  body . 

-.3 

+20.9 

-2 

+29 

Total:    Eighteen    experiments, 
average  of  60  days'  rest: 
In  digested  food 

16.6 
16.9 

227.3 

218.7 

2,428 
2,285 

104 
106 

In  material  oxidized 

Gain  or  loss  to  the  body . 

-.3 

+8.6 

-2 

+  13 

(b)  Work  Experiments 
E.  0. :  Two  experiments,  average 
of  8  days : 
In  food  digested 

17.6 
17.3 

326.2 
358.9 

2,462 
3,865 

110 

108 

In  material  oxidized 

Gain  or  loss  to  the  body . 

+.3 

-32.7 

+2 

-43 

A.  W.  S. :  One  experiment,  aver- 
age of  3  days 

14.8 
14.1 

223.6 
371.5 

2.505 
4;225 

92 

88 

In  food  digested 

In  material  oxidized 

Gain  or  loss  to  the  body . 

+.7 

-147.9 

+4 

-196 

HIGH    VERSUS   LOW   PROTEIN   DIET 


185 


INFLUENCE   OF  WORK  ON  THE  FOOD  REQUIRED    (ATWATER) 

Continued 


Character  and  Duration 
OP  THE  Experiment 

Nitrogen 
(Grams) 

Carbon 

(Grams) 

Energy 
(Calor.) 

Protein 

(Nx6.25) 
(Grams) 

Fat 

(Grams) 

J.  F.  S. :  Four  experiments,  aver- 
age of  12  days: 
In  food  digested 

15.0 
16.0 

306.4 
330.4 

3,251 
3,547 

94 
100 

In  material  oxidized 

Gain  or  loss  to  the  body . 

-1.0 

-24.0 

-6 

-27 

Total:   Seven   experiments,    23 

working   days'   average: 

In  food  digested 

15.9 
16.2 

302.5 
345.7 

3,227 
3,759 

99 
101 

In  material  oxidized 

Gain  or  loss  to  the  body . 

-.3 

-43.2 

-2 

-55 

HIGH  VERSUS  LOW  PROTEIN  DIET 

We  will  now  present,  from  Sherman's  (16)  summary  of  the  subject, 
some  of  the  arguments  which  have  been  advanced  in  favor  of  a  high  pro- 
tein and  of  a  low  protein  diet. 

"Liebig  believed  that  fats  and  carbohydrates  were  burned  in  the  body 
primarily  to  supply  it  with  warmth,  and  that  protein  alone  served  as  the 
source  of  muscular  work  and  other  forms  of  tissue  activity.  He  there- 
fore classed  the  non-nitrogenous  as  "respiratory"  and  the  nitrogenous  as 
"plastic"  foodstuffs,  and  treated  the  proteins  as  playing  a  "nobler"  part 
in  nutrition  than  can  be  accredited  to  either  fat  or  carbohydrate. 
Although  it  was  soon  demonstrated  that  carbohydrates  and  fats  as  well 
as  protein  serve  the  body  in  the  production  of  muscular  energy,  yet  the 
influence  of  Liebig's  teaching,  and  of  the  great  attention  given  to  pro- 
tein in  Voit's  classical  researches  on  nutrition,  together  with  the  fact 
that  protein  is  the  most  prominent  constituent  of  protoplasm,  has  resulted 
in  a  strong  tetidency  to  associate  high  protein  feeding  with  increased 
stamina  and  muscular  power. 

The  reasoning  of  those  who  appreciate  the  results  of  the  more  recent 
experimental  work,  and  yet  believe  the  general  attitude  of  Liebig  and 
Voit  to  have  been  largely  sustained  by  experience,  is  well  expressed  by 
von  N^oorden,  who  wrote (20)  :  "The  dietary  habits  of  peoples  are  the 
results  of  biological  laws,  and  it  would  seem  that  the  action  of  these 
laws,  extending  through  the  thousands  of  years  of  existence  of  the  species, 


186  PROTEIN^    AND    ]!^UTRITIOJ^ 

would  have  resulted  in  the  establishment  of  suitable  habits  regarding  the 
amounts  of  protein  consumed.  The  data  gathered  by  Voit  may  be  taken 
as  showing  that  this  normal  habit  involves  the  consumption  of  about 
105  grams  of  digestible  protein  per  day,  a  smaller  protein  consumption 
being*  usually  associated  with  weak  individuals  or  inactive  peoples. 
While  men  can  maintain  equilibrium  on  less,  still  it  can  rightly  be  said 
that  a  liberal  protein  consumption  makes  for  a  full  development  of  the 
man.  A  single  individual  may  for  years,  or  even  decades,  offend  against 
this  biological  law  unpunished.  When,  however,  the  small  consumption 
of  protein  continues  for  generations,  there  results  a  weak  race."  Von 
Xoorden,  however,  is  careful  to  add:  "On  the  other  hand,  the  impor- 
tance of  protein  must  not  be  overestimated.  A  diet  is  not  necessarily 
good  because  the  amount  of  protein  is  right;  it  must  have  the  proper 
proportions  of  the  non-nitrogenous  nutrients  as  well,  since  the  protein 
is  not  to  be  depended  upon  for  the  necessary  fuel  value.  Better  some- 
what less  protein  with  a  liberal  amount  of  total  food,  than  more  protein 
with  insufficient  fuel  value;  the  latter  brings  a  rapid  loss  of  strength, 
the  former  can  be  endured  very  well,  at  least  for  a  long  time,  and  very 
likely  throughout  the  life  of  the  individual." 

Hutchison (21)  advances  similar  views  in  regard  to  the  advantage  of 
a  liberal  protein  diet  and  definitely  pointed  out  that  generous  protein 
feeding  resulted  in  more  vigorous  health  •  and  increased  resistance. 

Chittenden,  in  100.5(22),  arrived  at  precisely  the  opposite  conclu- 
sion :  "The  products  of  protein  metabolism  are  a  constant  menace  to 
the  well-being  of  the  body,  and  any  excess  of  protein  over  what  the 
body  actually  needs  is  likely  to  be  directly  injurious,  and  at  best  puts 
an  unnecessary  and  useless  strain  upon  the  liver  and  kidneys."  Chit- 
tenden has  satisfied  himself,  by  his  numerous  and  long-continued  experi- 
ments, that  both  physical  and  mental  stamina  are  promoted  by  decreasing 
the  amount  of  protein  in  the  food.  Greater  freedom  from  fatigue, 
greater  aptitude  for  work,  greater  freedom  from  minor  ailments,  have 
gradually  become  associated  in  the  writer's  mind  with  this  lowered  pro- 
tein metabolism  and  general  condition  of  physiological  economy.  "The 
ordinary  professional  man  who  leads  an  active  and  even  strenuous  life, 
with  its  burden  of  care  and  responsibility,  need  not  clog  his  system  and 
inhibit  his  power  for  work  by  the  ingestion  of  an;^  such  quantities  of 
protein  food  as  the  ordinary  dietetic  standards  call  for." 

Although  Hutchison (23)  does  not  refute  his  early  teaching  in  regard 
to  the  views  of  a  high  protein  diet,  he  acknowledges  the  importance  of 
Chittenden's  work  and  states  that  such  a  diet  cannot  be  advocated   as 


HIGH   VEKSUS   LOW   PKOTEIN   DIET  187 

being  entirely  satisfactory.  In  his  nioro  recent  work  he  dechires(24)  that 
in  a  diet  yielding  «'3,0U0  calories,  the  normal  quantity  of  protein  should 
be  about  75  grams.  This  is  somewhat  in  excess  of  the  results  of  Chit- 
tenden's experiments,  but  is  in  accord  with  the  relation  of  protein  to 
calories  in  mothers'  milk.  This  proportion  Hutchison  considers  nature's 
teaching  concerning  the  normal  balance  of  nitrogenous  and  non-nitrog- 
enous food  for  man. 

Folin(25)  holds  that  the  argument  for  a  high  protein  diet,  based  on 
the  fact  that  large  amounts  of  protein  are  commonly  eaten  by  those  who 
can  afford  it,  can  be  equally  well  applied  to  tlie  dietetic  use  of  alcoholic 
beverages  and  is  no  more  convincing  in  one  case  than  in  the  other; 
while,  on  the  other  hand,  study  of  protein  metabolism  has  given  rather 
strong  evidence  that  the  body  has  no  need  of  such  amounts  as  are  com- 
monly eaten,  for  when  protein  is  fed  the  nitrogen  which  it  contains  is 
usually  eliminated  more  quickly  than  the  carbon,  and  further  study  indi- 
cates that  a  considerable  part  of  the  nitrogen  absorbed  from  the  ali- 
mentary tract  never  reaches  the  tissues  at  all,  but  is  converted  into  urea 
on  its  first  passage  through  the  liver. 

Protein  Diet  and  the  Nitrogen  Equilibrium. — The  loss  of  body  nitrogen 
which  occurs  in  the  early  periods  of  restricted  protein  feeding,  and  which 
was  not  determined  nor  specifically  discussed  by  Chittenden,  is  treated 
by  Folin  as  follows : 

"All  the  living  protoplasm  in  the  animal  organism  is  suspended  in  a 
fluid  very  rich  in  protein,  and  on  account  of  the  habitual  use  of  more 
nitrogenous  food  than  the  tissues  can  use  as  protein,  the  organism  is 
ordinarily  in  possession  of  approximately  the  maximum  amount  of  resei*ve 
protein  in  solution  that  it  can  advantageously  retain.  When  the  supply 
of  food  protein  is  stopped,  the  excess  of  reserve  protein  inside  the 
organism  is  still  sufficient  to  cause  a  rather  large  destruction  of  protein 
during  the  first  day  or  two  of  protein  starvation,  and  after  that  the  pro- 
tein catabolism  is  very  small,  provided  sufficient  non-nitrogenous  food  is 
available.  But  even  then,  and  for  many  days  thereafter,  the  protoplasm 
of  the  tissues  has  still  an  abundant  supply  of  dissolved  protein,  and  the 
normal  activity  of  such  tissues  as  the  muscles  is  not  at  all  impaired  or 
diminished." 

When  30  or  40  grams  of  nitrogen  have  been  lost  by  an  average-sized 
man  during  a  week  or  more  of  abstinence  from  nitrogenous  food  (biit 
with  an  abundance  of  carbohydrate  and  fat),  the  living  muscle  tissues 
are  still  well  supplied  with  all  the  protein  that  they  can  use.  That  this 
is  so  is  indicated,  on  the  one  hand,  by  the  unchanged  creatinin  elimina- 


188  PROTEIN    AND    NUTRITION 

tiou,  and  on  the  other  by  the  fact  that  one  experiences  no  feeling  of 
unusual  fatigue  or  of  inability  to  do  one's  customary  work.  Because 
the  organism  at  the  end  of  such  an  experiment  still  has  an  abundance 
of  available  protein  in  the  nutritive  fluids,  it  is  at  once  seemingly  waste- 
ful with  nitrogen  when  a  return  is  made  to  nitrogenous  food.  This  is 
why  only  gradually,  and  only  under  prolonged  pressure  of  an  excessive 
supply  of  food,  protein  again  actjuires  its  original  maximum  store  of 
this  reserve  material. 

If  the  interpretation  just  given  for  the  phenomenon  of  nitrogen 
equilibrium  is  correct,  it  constitutes  at  the  same  time  a  definite  reason 
why  the  so-called  standard  diets  are  unnecessarily  rich  in  protein.  Nitro- 
gen enough  to  provide  liberally  for  the  endogenous  metabolism  and  for 
the  maintenance  of  a  sufficient  supply  of  the  reserve  protein  is  shown 
to  be  necessary;  but  it  ought  neither  to  be  necessary  nor  advantageous 
for  the  organism  to  split  olf  and  remove  large  quantities  of  nitrogen 
which  it  can  neither  use  nor  store  up  as  reserve  material.  In  the  case 
of  carnivorous  animals,  the  uncertainty  of  the  food  supply  has  evidently 
led  to  the  development  of  a  capacity  to  store  a  certain  amount  of  pro- 
tein in  the  form  of  increased  muscle  substance,  but  in  man  this  capacity 
seems  not  to  exist.  The  slowness  with  which  the  normal  human  organism 
stores  nitrogen  after  having  lost  only  very  moderate  amounts  does  not 
mean  that  the  human  organism  can  replace  lost  muscle  tissue  only  slowly 
and  with  difficulty.  When  the  organism  really  has  suffered  a  loss  of 
such  tissue,  as,  for  example,  during  typhoid  fever,  we  know  that  during 
convalescence  there  is  an  astonishingly  rapid  recovery  of  weight  and  a 
correspondingly  extensive  retention  of  nitrogen. 

In  the  light  of  the-  theory  developed  from  Folin's  teaching  concern- 
ing the  double  nature  of  protein  metabolism  and  the  explanation  of  the 
phenomenon  of  nitrogen  equilibrium,  the  following  objection  can  perhaps 
be  made  to  the  use  of  large  quantities  of  protein :  the  excess  of  nitrogen 
furnished  with  the  food  is  normally  quickly  converted  into  urea  and 
eliminated,  and  is  therefore  normally  harmless.  The  continuous  ex- 
cessive use  of  protein  may  lead,  however,  to  an  accumulation  of  a  larger 
amount  of  reserve  protein  than  the  organism  can  with  advantage  retain 
in  its  fluid  media.  It  is  entirely  possible  that  the  continuous  main- 
tenance of  such  an  unnecessarily  large  supply  of  unorganized  reserve 
material  may  sooner  or  later  weaken  one  or  another  or  all  of  the  living 
tissues.  At  any  rate,  it  seems  scarcely  conceivable  that  the  human  organ- 
ism, having  all  the  time  access  to  food,  can  gain  in  efficiency  on  account 
of  such  an  excess  of  stored  protein.     The  carrying  of  excessive  quantities 


HIGH   VERSUS   LOW   PROTEIN   DIET  189 

of  fat  is  considered  as  an  impediment ;  the  carrying  of  excessive  quanti- 
ties of  unorganized  protein  may  be  none  the  less  so  because  more  common 
and  less  strikingly  apparent  (26). 

Halliburton (27),  in  discussing  the  work  of  Chittenden  and  of  Folin, 
concedes  that  "the  prevalence  of  dyspeptic  troubles  and  uric  acid  disorders 
(among  the  English-speaking  peoples)  should  make  lis  hesitate  before 
we  conclude  that  our  diet  has  reached  the  stage  of  perfection,  and  should 
rather  lead  us  to  admit  that  the  majority  of  well-to-do  people  eat  too 
much  protein" ;  but,  he  adds,  "Any  change  in  the  practice  of  years  and 
of  generations  should  be  accomplished  gradually,  not  suddenly.  It  is 
well  known  that  the  liver  is  the  largest  organ  we  possess,  and  one  of  its 
functions  is  to  convert  nitrogenous  metabolites,  which  may  be  harmful, 
into  urea,  which  is  harmless  and  easily  disposed  of,  and  one  may  gain 
comfort  from  the  reflection  that  the  organ  is  adequate  in  health  to  deal 
with  large  quantities  of  material.  If  all  of  us  were  inmiediately  to 
reduce  our  diet  to  the  Chittenden  level,  we  might  be  living  perilously 
near  the  mflrgin;  any  unusual  strain,  such  as  privation  or  a  severe  ill- 
ness, would  then  find  us  without  any  reserve  of  nutrient  energy,  and 
we  should  probably  suffer  more  severely  in  consequence." 

Benedict (28),  after  many  years'  experience  in  feeding,  favors  the 
use  of  liberal  quantities  of  protein,  and  says,  "While  men  may  for  some 
months  reduce  the  proportion  of  protein  in  their  diet  very  markedly 
and  apparently  suffer  no  deleterious  consequences,  yet,  nevertheless,  a 
permanent  reduction  of  the  protein  beyond  that  foimd  to  be  the  normal 
amount  for  man  is  not  without  possible  danger.  The  fact  that  a  subject 
can  so  adjust  an  artificial  diet  as  to  obtain  nitrogenous  equilibrium  with 
an  excretion  of  nitrogen  amounting  to  about  two  or  three  grams  per  day 
is  no  logical  argument  for  the  permanent  reduction  of  the  nitrogen  in 
food  for  the  period  of  a  lifetime.  Dietary  studies,  all  over  the  world, 
show  that  in  those  communities  where  productive  power,  enterprise  and 
civilization  are  at  their  highest,  man  has  instinctively  and  independently 
selected  liberal  rather  than  small  quantities  of  protein." 

A  similar  position  is  taken  by  Meltzer(29),  who  compares  the  appe- 
tite for  a  liberal  surplus  of  protein  with  the  liberal  way  in  which  the 
body  is  provided  with  organs  and  tissues  for  nearly  all  of  its  functions, 
and  concludes  that,  "valuable  as  the  facts  which  Chittenden  and  his 
co-laborer  found  may  be,  they  do  not  make  obvious  their  theory  that 
the  minimum  supply  is  the  optimum — the  ideal."  The  bodily  health 
and  vigor  which  people  with  one  kidney  still  enjoy  does  not  make  the 
possession  of  only  one  kidney  an  ideal  condition. 


190  PIIOTEIN    AND    NUTIUTION 

''The  finding  that  the  accepted  standard  of  protein  diet  can  be  reduced 
to  one-half  can  be  compared  with  the  finding  that  the  inspired  oxygen 
can  be  reduced  to  one-half  without  affecting  the  health  and  comfort  of 
the  individual,  but  no  one  deduces  from  the  latter  fact  that  the  breathing 
of  air  so  rarefied  would  be  the  ideal.  The  storing  away  of  protein,  like 
the  storing  away  of  glycogen  and  fat,  for  use  in  expected  and  unexpected 
exceptional  conditions  is  exactly  like  the  superabundance  of  tissues  in 
an  organ  of  an  animal,  or  like  an  extra  beam  in  the  support  of  a  building 
or  a  bridge — a  factor  of  safety.  We  therefore  believe  that  with  regard 
to  the  function  of  supply  of  tissues  and  energy  by  means  of  protein  food 
nature  meant  it  should  be  governed  by  the  same  principle  of  affluence 
which  governs  the  entire  construction  of  the  animal  for  the  safety  of  its 
life  and  the  perpetuation  of  its  species." 

After  considering  the  arguments  of  Benedict  and  of  Meltzer,  it  is 
noteworthy  that  in  his  later  book  Chittenden (30)  says:  "It  is  certainly 
just  as  plausible  to  assume  that  increase  in  the  consumption  of  protein 
food  follows  in  the  footsteps  of  commercial  and  other  forms  of  pros- 
perity, as  to  argue  that  prosperity  or  mental  and  physical  development 
are  the  result  of  an  increased  intake  of  protein  food.  Protein  foods  are 
usually  costly  and  the  ability  of  a  community  to  indulge  freely  in  this 
form  of  dietetic  luxury  depends  in  large  measure  upon  its  commercial 
prosperity."  Moreover,  Chittenden  contends  that  his  allowance  of  (50 
grams  of  protein  per  day  for  a  man  of  average  size  is  a  perfectly  trust- 
worthy figure,  with  a  reasonable  margin  of  safety;  that  dietetic  require- 
ments, and  standard  dietaries,  are  not  to  be  founded  upon  the  so-called 
cravings  of  appetite,  but  upon  reason  and  intelligence  reenforced  by 
definite  knowledge  of  the  real  necessities  of  the  bodily  machinery. 

"We  must  ever  be  mindful  of  the  fact,  so  many  times  expressed,  that 
protein  does  not  undergo  complete  oxidation  in  the  body  to  simple  gaseous 
products  like  the  non-nitrogenous  food,  but  that  there  is  left  behind  a 
residue  not  so  easily  disposed  of,  and  that  there  are  many  suggestions 
of  improvement  in  bodily  health,  of  greater  efficiency  in  working  power 
and  of  greater  freedom  from  disease,  in  a  system  of  dietetics  which  aims 
to  meet  the  physiological  needs  of  the  body  without  undue  waste  of 
energy  and  unnecessary  drain  upon  the  functions  of  digestion,  absorp- 
tion, excretion  and  metabolism  in  general." 

Reduction  of  Protein  Dietary  Necessary. — The  well-to-do  families  and 
those  living  in  luxury  should  especially  avoid  the  excessive  and  exclusive 
ingestion  of  foods  from  the  animal  kingdom.  There  are  tables  in  some 
families  from  which  vegetables  are  almost  entirely  excluded,  because  it 


HIGH  VERSUS  LOW   PROTEIN  DIET  191 

is  said  they  are  not  sufficiently  nourishing  or  because  they  do  not  make 
a  big  enough  show,  or  because  they  do  not  satisfy  palates  accustomed  to 
animal  foods;  sometimes  because  their  preparation  requires  more  pains- 
taking care  and  time  than  the  housewife  or  cook,  often  from  indolence, 
cares  to  give  them.  Again,  some  individuals  seem  to  think  that  an 
excess  of  nitrogenous  alimentation  will  make  up  for  any  deficiency,  in- 
tentional or  otherwise,  of  vegetable  foods.    This  is  a  very  dangerous  error. 

On  such  a  dietary  children  are  slow  in  development,  nervous,  caco- 
chymic  and  eczematous.  In  later  life  they  will  be  subjects  of  rheumatism, 
gout,  calculi  and  nervous  disorders.  There  is  no  question  in  our  mind 
but  that  the  degeneracy  noted  in  many  well-to-do  families  is  due  wholly, 
or  in  part,  to  a  dietary  composed  too  exclusively  of  foods  from  the  ani- 
mal kingdom.  For  this  reason,  which  we  cannot  too  strongly  emphasize, 
we  ought  not  to  further  encourage  this  tendency  by  replacing  beef  and 
mutton,  roast  or  boiled,  by  pork,  butcher's  meat,  hash,  game,  preserved 
fish,  spiced  stews,  salt  or  smoked  meats,  by  meat  of  animals  too  young 
and  by  fermented  cheeses  with  the  necessary  accompaniment  of  bitters, 
stimulants,  spices,  wines,  liqueurs,  coffee,  tea,  etc.  Such  a  dietary, 
beyond  question,  augments  every  sort  of  disorder  of  health,  leads  to  race 
degeneracy  and  decimates  families. 

It  is  beyond  question  that  the  dietary  habit  of  well-to-do  people, 
especially  Americans,  and  the  dietary  standards  which  have  been  gen- 
erally accepted  in  the  past,  tend  to  be  decidedly  liberal  with  respect  to 
protein.  The  custom  of  physicians  and  dietitians  has  been  to  prescribe 
protein  in  quantities  which  may  be  believed  to  be  beneficial,  but  it  is 
knoven  to  a  certainty  that  it  is  not  necessary  in  the  amounts  usually 
allowed. 

Effect  of  Increased  Nitrogen  Diet  on  Kidneys. — Careful  observers  have 
proved  that  half  the  standard  allowance  of  protein  has  amply  met  the 
demands  of  the  body  for  nitrogen,  but  it  has  also  been  shown  that  any- 
thing more  than  the  amount  necessary  for  the  formation  and  repair  and 
wear  and  tear  of  muscular  tissues  is  rapidly  disintegrated  and  the  urea 
moiety  thrown  out  of  the  body;  and  it  is  further  claimed  that  the  addi- 
tional amount  which  is  usually  consumed  is  harmful  to  the  organism 
by  throwing  extra  work  upon  the  kidneys  to  excrete  it.  It  is  also  claimed 
that  this  extra  work  thrown  on  the  organs  of  elimination  in  turn  is  the 
cause  of  gout,  migraine  and  kindred  ailments. 

It  is  a  physiological  fact  that  nitrogen  may  be  speedily  eliminated, 
and  it  has  been  demonstrated  that  the  amoimt  of  nitrogen  metabolized 
is  in  proportion  to  the  amount  consumed.     We  have  already  shown  that 


192  PEOTEIN    AXD    NUTRITIOi^ 

the  amount  of  urea  excreted  with  an  ordinary  mixed  ration  varies  from 
33  to  37  grams  daily;  but  when  an  extra  amount  of  protein  is  ingested 
the  excretion  of  urea  may  rise  to  50,  60  or  even  100  grams  per  day. 
On  a  non-protein  diet  for  several  days'  duration  the  excretion  of  urea 
may  sink  to  9  grams.  On  a  diet  poor  in  protein  it  may  drop  to  15  or 
20  gTams. 

The  function  of  the  kidneys  is  that  of  elimination,  so  that  the  excre- 
tion of  urea  in  moderate  quantities  is  not  injurious.  It  may  be  granted 
that  if  the  function  of  the  kidneys  is  defective,  there  will  be  a  retention 
of  urea  or  other  nitrogenous  waste  products  in  the  body  and  the  organism 
will  suffer  accordingly.  Yet,  on  the  other  hand,  there  are  certain  sec- 
tions of  the  earth  where  the  inhabitants  live  for  months  upon  flesh,  fish 
and  fowl,  and  they  do  not  appear  to  suffer  more  than  Americans  or  Euro- 
peans who  live  on  a  mixed  diet.  It  is  known  that  carnivorous  animals 
subsist  entirely  on  flesh,  and  there  is  no  evidence  that  they  suffer  from 
disease  of  the  kidneys,  from  the  overwork  of  their  organs.  Moreover, 
it  has  been  satisfactorily  demonstrated  that  when  the  amount  of  protein 
in  their  food  sinks  below  the  normal  level,  they  soon  begin  to  suffer  from 
digestive  disturbances. 

Effect  of  Protein  Diet  on  Strength  and  Endurance — effect  of  low 
PEOTEIX  DIET  OX  AXi:maL8.— ^lunk  of  Berlin  (31)  made  a  series  of 
observations  to  determine  the  effects  of  a  low  protein  diet  on  dogs ;  he 
observed  that  a  ration  poor  in  protein  caused  disturbances  of  the  organ- 
ism, seriously  interfering  with  assimilation ;  the  absorption  of  fat  was 
the  most  disturbed,  that  of  protein  next,  and  that  of  carbohydrates  the 
least  molested  of  all.  The  animals  did  not  recover  their  nitrogenous  and 
nutritional  equilibrium  until  their  protein  ration  was  increased.  Wlien 
they  were  allowed  skim  milk,  beans  or  other  nitrogenous  food,  a  distinct 
improvement  in  their  condition  was  noticeable.  It  is  well  known  to  the 
farmer  that  bacon  from  pigs  fattened  on  a  low  protein  diet  is  poor  in 
(juality.  It  is  also  well  known  that  the  milk  of  cows  fed  on  a  ration 
deficient  in  protein  is  poor  in  fat ;  the  cows  become  thin,  their  coats  harsh, 
and  they  present  an  ill-fed  and  ill-kept  appearance. 

Observations  of  the  effects  of  the  different  food  elements  on  man  are 
confirmed  by  these  experiments  upon  lower  animals.  Although  it  is 
known  that  individuals  can  live  and  continue  to  keep  up  both  health 
and  work  for  months  on  a  diet  poor  in  protein,  nevertheless  this  course 
cannot  be  continued  for  an  indefinite  period.  After  a  time  vitality  is 
lowered,  resistance  to  disease  is  weakened,  the  activity  of  the  bodv  is 
lessened  and  the  powers  of  endurance  are  stunted.     Both  careful  obser- 


HIGH    VEKSLS    LOW    PK(JTK1X    DIET  193 

vatioii  and  ex])erieiK'e  point  to  the  disadvantages  of  a  low  j)i'<Jtein 
diet. 

The  expenditure  of  energy  is  required  by  muscular  work,  and  to  tins 
end  more  fuel  must  be  consumed.  It  has  been  demonstrated  that  for  the 
production  of  energy,  protein,  fat  and  carbohydrate  can  be  interchanged 
in  a  definite  proportion.  It  has  also  been  demonstrated  that  the  increased 
excretion  of  nitrogen  during  and  after  nuiscular  work  is  not  in  propor- 
tion to  the  amount  of  work.  On  the  contrary,  the  energy  expended  in 
doing  work  is  derived  in  great  part  from  non-nitrogenous  foods. 

It  is  evident,  therefore,  to  the  careful  student  of  dietetics  that  when 
extra  work  is  to  be  performed  a  more  liberal  allowance  of  fat  and  carbo- 
hydrate must  be  added  to  the  ration.  But  this  point  is  not  settled  beyond 
dispute,  since  it  has  been  the  custom  for  ages  past  to  increase  the  total 
food  protein  in  proportion  to  the  extra  work  to  be  done.  However,  from 
the  viewpoint  of  endurance  it  is  generally  accepted  as  a  fact  that  men 
who  partake  liberally  of  animal  foods  are  more  powerful  and  have 
greater  staying  qualities  than  those  who  consume  little  meat (32).  The 
carnivora  are  more  powerful  and  energetic  than  the  herbivora.  The 
lion  or  tiger  is  more  vicious  than  the  deer  or  elk.  "Horses  fed  on  beans 
or  oats  have  more  spirit  and  endurance  than  those  fed  on  hay  or  grass." 
It  is  an  indisputable  fact,  nevertheless,  that  feats  of  endurance  can  be 
performed  on  a  purely  vegetarian  diet;  but  this  may  not  necessarily  be 
deficient  in  protein,  so,  after  all,  it  makes  no  difference  whether  the  pro- 
tein is  taken  from  the  animal  or  vegetable  kingdom. 

The  difference  between  an  animal  fed  on  a  liighly  nitrogenous  diet 
and  one  supplied  with  little  nitrogen  is  the  difference  between  a  steam 
engine  at  half  pressure  and  one  which  is  producing  its  full  horse  power. 
It  is  the  difference  between  a  tiger  pacing  its  cage  and  a  cow  lying  upon 
the  grass;  both  are  healthy,  but  the  type  or  degree  of  health  is  very 
different  in  the  two  animals.  "A  hunted  deer,"  says  Ilaughton,  "will 
outrun  a  leopard  in  a  fair  and  open  chase,  because  the  work  supplied  to 
its  muscles  by  the  vegetable  food  is  capable  of  being  given  out  continu- 
ously for  a  long  period  of  time,  but  in  a  sudden  rush  at  a  near  distance, 
the  leopard  will,  without  doubt,  overtake  the  deer,  because  its  flesh  food 
stores  up  in  the  body  a  reserve  or  force  capable  of  being  given  out 
instantaneously  in  the  form  of  exceedingly  rapid  muscular  action." 

FKOTEIN  DIET  AND  OCCUPATION.— Before  concluding  this  subject, 
we  desire  to  call  attention  to  the  disadvantages  of  a  purely  vegetable 
diet,  which  affects  the  outdoor  laborer  much  less  than  the  one  engaged 
in  sedentary  vocations.     The  laborer  or  lumberjack  actually  requires  a 


194  PROTEIN    AND    NUTRITION 

large  amount  of  carbohydrate  food  to  enable  him  to  perform  his  muscular 
work,  and  in  partaking  of  large  quantities  of  vegetable  foods  for  this 
purpose  he  is  pretty  sure  to  get  as  much  protein  as  his  body  requires. 
The  free  action  of  the  skin,  too,  from  his  strenuous  exertions  carries 
off  from  the  body  the  excess  of  water  which  his  diet  contains,  while  his 
active  work  in  the  open  air  induces  an  appetite  for  large  meals.  With 
the  sedentary  worker  the  case  is  different.  He  requires  much  less  carbo- 
hydrate food  than  the  laborer  taking  strenuous  exercise  in  the  open  air, 
while  his  body  demands  considerable  protein.  In  endeavoring  to  obtain 
from  purely  vegetable  sources  a  sufficiency  of  nitrogenous  food,  he  would 
inevitably  overburden  his  diet  with  an  excess  of  non-nitrogenous  foods, 
which  his  comparatively  feeble  digestion  would  be  unable  to  metabolize, 
while  his  skin  would  not  act,  as  in  the  case  of  the  laborer,  to  rid  the 
body  of  the  surplus  water  which  such  a  diet  would  contain.  For  these 
reasons,  a  man  of  sedentary  occupations  is  much  less  likely  to  be  a  suc- 
cessful example  of  vegetarianism  than  one  who  leads  an  active  life. 

THE  AMINO-ACIDS  IN  ANIMAL  AND  VEGETABLE  PROTEINS.— In  study- 
ing the  physiology  of  absorption  (Volume  I,  Chapter  VI)  we  learned 
that  all  proteins,  whether  from  the  vegetable  or  animal  kingdom,  consist 
of  amino-acids(33).  The  amino-acids  of  animal  proteins  are  identical 
with  those  of  vegetable  proteins,  and  therefore  it  would  appear  a  priori 
that  there  can  be  little  difference  in  their  value  upon  the  organism.  It 
is  a  remarkable  fact  that  the  most  valuable  vegetable  proteins  are  defi- 
cient in  flavoring  agents,  while  these  bodies  in  meat,  fowl  and  fish  add 
to  their  palatability. 

Minimum  Protein  Requirement  to  Maintain  Nitrogen  Equilibrium The 

evidence  advanced  by  some  observers  that  the  amount  of  protein  pre- 
scribed in  standard  diet  is  injurious  to  the  organism  is  not  conclusive, 
but  there  is  ample  evidence  of  the  bad  effects  of  a  long-continued  diet 
of  low  protein  value.  Cohnheim  holds  that  Chittenden's  experiments 
do  not  prove  that  men  eat  too  much  protein,  believing  that  they  can  live 
for  a  time  upon  a  smaller  amount  of  protein  than  usual.  He  believes 
that  most  men  cannot  continue  to  live  upon  an  allowance  of  from  50  to 
60  grams  of  protein  and  keep  in  good  health.  With  Caspari  and  Loewi 
he  holds  that  a  healthy,  full-grown  man  requires  at  least  80  grams  of 
protein  daily,  and  this  is  a  considerable  reduction  from  the  standard 
diet.  We  can  safely  take  Chittenden's  experiments  as  the  protein  mini- 
mum of  the  so-called  standard  dietaries  which  show  that  the  customary 
or  average  protein  consumption  of  the  most  successful  nations  represents 
the  necessary  amount  or  optimum  protein  consumption,  but  Folin  holds 


HIGH   VERSUS   LOW   PROTEIN   DIET  195 

to  the  view  that  the  protein  optimum  lies  somewhere  between  these  two 
points. 

The  minimum  ration  of  protein  to  secure  nitrogenous  equilibrium 
was  fixed  hy  Voit  at  118  grams  in  twenty-four  hours,  while  Miller 
asserts  that  the  minimum  nitrogenous  ration  has  been  fixed  too  high, 
and  that  00  grams  of  protein  should  be  considered  the  minimum.  This 
coincides  with  the  teaching  of  Chittenden,  who  agrees  that  60  grams  of 
protein  are  insufiicient;  and  again  Rubner  believes  the  daily  necessary 
potential  would  be  maintained  by  35  grams  of  protein  for  an  adult  in 
whom  growth  was  complete.  Klemperer  was  able  to  maintain  nitrogenous 
equilibrium  on  33  grams  of  protein  by  giving  at  the  same  time  a  liberal 
allowance  of  fats  and  carbohydrates. 

Siven,  in  his  interesting  work (34),  and  Peschel,  in  his  inaugural 
address  (35),  prove  that  nitrogenous  equilibrium  may  be  secured  with 
an  alimentation  containing  only  40  grams  of  protein,  and  that,  imder 
these  conditions,  the  organism  does  not  draw  in  the  slightest  manner 
upon  its  own  protein,  provided  the  quantity  of  calories  lacking  is  made 
up  by  a  liberal  allowance  of  fats  and  carbohydrates. 

Hutchison  (36),  although  acknowledging  that  Chittenden's  results 
show^  what  men  can  exist  upon,  holds  that  their  general  application  would 
be  attended  with  risk.  In  solving  the  problem  of  protein  requirements, 
Hutchison  makes  an  interesting  comparison  between  the  diet  of  an  adult 
and  that  of  a  nursing  infant.  The  daily  supply  of  milk  taken  by  an 
infant  six  months  of  age  contains  about  14  grams  of  protein,  furnishing 
578  calories;  the  average  energy  value  of  the  food  of  an  adult,  on  the 
other  hand,  equals  3,000  calories,  i.e.,  the  standard  of  protein,  in  the 
same  proportion,  would  be  about  Y5  grams,  the  infant's  growth  being 
offset  by  the  daily  expenditure  of  energy  in  the  routine  life  of  an  adult. 
Halliburton's  results  coincide  with  the  results  of  Chittenden's  experi- 
ments with  metabolism  and  he  points  out  the  danger  of  living  too  near 
the  protein  minimum. 

Safety  Standard  in  Diet. — It  may  be  definitely  concluded  that  the 
body  must  have  the  minimum  of  protein,  an  increased  proportion  being 
of  value  because  of  its  action  as  a  stimulant  to  metabolism  and  as  an 
accessible  source  of  energy ;  that  the  ingestion  of  protein  in  larger  amounts 
than  Chittenden's  standard  is  advisable,  since  it  increases  resistance  to 
disease,  probably  due  to  the  manufacture  of  antibodies  resulting  from 
the  stimulation  of  the  body  to  this  end.  The  fact  tliat  those  who  are 
forced  by  their  lack  of  means  to  live  on  a  low  protein  diet  are  more  sus- 
ceptible to  disease  has  long  been  accepted.     A  definite  quantity  to  be 


196  PROTEIN    AND    NUTRITION 

known  as  the  protein  optimum  cannot  be  fixed,  for  it  is  doubtless  influ- 
enced in  the  case  of  every  individual  bj  the  personal  equation.  The 
pivot  on  which  the  protein  problem  rests  is  the  question  of  the  desirabil- 
ity of  storing  proteins  and  of  maintaining  them  on  a  high  level  or  on  a 
low  level.  For  certain  individuals  a  high  level  is  better,  for  others  a  low 
level,  on  the  condition  that  the  alimentary  organs  are  able  to  digest  and 
assimilate  proteins,  and  the  kidneys  are  able  to  transform  the  nitrogenous 
waste  into  urea  for  ultimate  excretion.  The  young  thrive  on  protein 
food ;  during  the  period  of  middle  age,  however,  the  metabolic  processes 
are  less  active,  and  then  protein  ingested  in  amounts  greater  than  the 
physiological  requirements  tends  to  a  condition  of  obesity,  and  the  urea 
is  not  eliminated  with  as  much  facility  because  of  decreased  hepatic 
efficiency  and  lessened  activity  of  the  renal  excretory  power.  With  these 
conditions  present,  the  amount  of  protein  in  the  dietary  must  be  held 
down,  so  that  the  optimum  at  this  epoch  falls  below  that  of  youth  and 
early  adult  life. 

CAUTION  AS  TO  PROTEIN"  DEFICIENCY.— Before  leaving  this  subject 
we  desire  to  urge  a  word  of  caution  against  a  deficiency  of  food  in  the 
diet — protein,  being  the  most  costly,  is  the  principle  most  likely  to  be 
short  in  the  diet.  Of  late,  considerable  discussion — as  emphasized  by 
experiences  recorded  in  this  chapter — has  arisen  as  to  the  exact  amount 
of  protein  required  daily  by  the  adult  after  the  period  of  growth  is 
complete.  For  generations  past  it  has  been  considered  that  protein 
starvation  is  the  cause  of  much  ill  health  and  misery.  In  our  own 
country,  among  the  poorer  classes  in  the  South,  particularly  in  the 
mountain  districts  and  among  the  poorer  children  working  in  factories, 
it  is  not  uncommon  for  individuals  to  live  upon  a  diet  in  which  "tea, 
bread  and  butter"  figure  prominently,  with  an  occasional  bloater  or 
other  appetizer.  While  such  a  diet  may  yield  sufficient  heat  to  supply 
the  demands  of  the  body  according  to  scientific  requirements,  it  does 
not  give  the  consumer  strength  and  endurance.  The  general  principles 
laid  down  in  this  chapter  should  guide  us  in  directing  a  diet  for  people 
of  this  type,  and  especially  where  the  cost  of  meat,  fish,  fowl,  eggs  or 
milk  is  prohibitive,  to  suggest  and  direct  the  freer  use  of  beans,  peas, 
lentils  and  nuts  which  would  supply  the  necessary  protein  to  make  up  a 
well-balanced  ration  vn'thout  an  excessive  expenditure  of  money. 

UNDEREATING. —  ITndereating  is  often  coupled  with  indigestion  in 
such  a  way  that  it  is  impossible  to  say  whicli  is  the  cause  and  which 
the  effect.  Within  wide  limits  the  digestive  glands  accommodate  them- 
selves to  the  tax  levied  upon  them,  providing  adequate  amounts  of  their 


HIGH   VERSUS   LOW   PROTEIN   DIET  197 

juices  for  large  or  small  meals.  Low  diet,  therefore,  may  weaken  the 
adaptability  of  the  organs  it  is  designed  to  spare  (Howell). 

Benedict,  of  the  Carnegie  Nutrition  Laboratory,  has  severely  criti- 
cized those  writers  who  go  to  extreme  lengths  in  their  championship  of 
reduced  feeding.  He  has  shown  that  when  the  food  supply  is  very  small 
the  absorption  is  often  less  complete  than  with  a  more  liberal  diet, 
indicating  that  the  digestive  system  is  not  in  such  good  working  order 
as  it  might  be  with  more  to  do.  Chittenden,  the  foremost  advocate  of 
careful  restriction,  agrees  with  his  critic  to  this  extent  at  least — that 
he  believes  that  an  occasional  big  dinner  is  a  valuable  means  of  testing 
the  canal  to  see  whether  it  has  retained  the  reserve  power  which  it 
should  have.  We  must  admit,  in  spite  of  the  scientific  investigations 
laid  down  for  the  bodily  requirements  of  persons  in  adult  life,  that  these 
standards  are  subject  to  a  personal  equation  which  will  upset  the  calcu- 
lation, and  therefore  the  scientific  figures  can  only  be  considered  as 
general  averages. 

OVERFEEDING. — Overfeeding,  especially  in  youth  and  early  adult 
life,  may  be  disposed  of  by  quick  digestion  and  speedy  assimilation, 
great  metabolic  activity  and  greater  physical  exercise,  whereby  the  ex- 
cess of  food  consumed  is  rapidly  used  up  and  eliminated;  but  when  the 
middle  mile  post  in  life's  journey  is  reached,  the  body  is  less  active 
and  the  same  interest  is  not  taken  in  cricket,  football,  golf  and  other 
outdoor  games  as  in  early  life.  Consequently,  less  food  is  metabolized 
and  the  "undesirable  balance"  remains  as  a  "sin  against  Nature."  It 
is  quite  true  that  a  certain  portion  of  this  surplus  may  be  stored  up  in 
the  body  as  protein,  glycogen  and  fat  and  may  thereby  lead  to  obesity. 
On  the  other  hand,  there  are  persons  who  "love  to  eat  large  meals," 
who  lead  an  inactive  life,  follow  sedentary  occupations  and  live  in  warm 
rooms  "lapped  in  luxury,"  who  never  put  on  flesh.  Luxurious  habits, 
especially  overindulgence  in  meat,  give  rise  to  various  stomach,  kidney 
and  arthritical  complaints.  Even  though  it  may  be  taken  into  account 
that  gourmands  are  the  most  frequent  sufferers  from  the  above  disorders, 
this  does  not  settle  the  matter,  for  he  who  "eats  well"  often  "drinks 
well,"  and  which  of  the  two  is  the  culprit,  the  protein  or  the  alcohol? 
In  the  majority  of  instances  it  might  be  safe  to  assume  that  these  boon 
companions  share  the  responsibility  between  them.  But  this  "unde- 
sirable balance"  is  the  causative  factor  in  a  variety  of  ills,  such  as  bilious 
attacks,  migraine,  headache,  lethargy,  diseases  of  the  liver,  kidneys, 
blood  vessels,  and  favors  the  production  of  rheumatism  and  gravel  and 

kindred   affections,   not   to   mention   the  various   auto-intoxications   and 
113 


198  PEOTEIi^    AND    NUTRITION 

putrefactive  stasis  of  the  alimentary  canal.  The  decomposition  of  the 
end-products  of  protein  digestion  takes  place  in  the  colon ;  hence,  in  this 
region,  products  of  decomposition  develop,  such  as  indol,  phenol,  skatol, 
volatile  fatty  acids,  aromatic  acid,  ammonia,  carbonic  acid,  methane, 
sulphuretted  hydrogen  and  methyl  mercaptan. 

The  Greek  and  Spartan  athletes  of  old  were  wholly  or  mainly 
abstainers  from  flesh  foods,  and  won  in  all  strenuous  combats,  until  they 
began  to  eat  flesh  to  make  themselves  "fierce,"  after  which  they  began 
to  lose  in  their  conquests  in  the  stadium.  The  diet  of  the  country 
laboring  classes,  for  half  a  century  past,  was  almost  wholly  innocent  of 
flesh  meats  and  strong  drinks,  and  it  must  be  borne  in  mind  that  it  is 
to  this  sober  and  temperate  ancestry  that  the  working  powers  of  this 
present  generation  are  owed.  The  use  of  flesh  in  the  daily  ration  of 
food  dates  from  hardly  more  than  one  quarter  of  a  century  among  the 
peasantry  of  the  most  rural  districts,  and  already  they  are  beginning  to 
degenerate. 

ILL-EFFECTS  OF  ABSORPTION  OF  END-PRODUCTS  OF  PROTEIN  DIGES- 
TION.— Does  muscular  strength  decline  on  a  rich  protein  (meat)  diet? 
Physicians  are  well  aware  of  the  weakening  effect  of  a  meat  diet  such 
as,  in  the  past,  has  been  prescribed  for  diabetics.  If  the  lower  protein 
estimate  of  Chittenden  and  others,  say  of  60  grams,  be  sufficient,  is  it 
not  a  question,  then,  of  serious  moment  to  tax  severely  the  organs  of 
digestion  and  assimilation  with  from  120  to  200  grams  of  protein  ? 
The  end-products  of  protein  digestion  which  cannot  be  entirely  con- 
sumed in  the  body  leave  behind  a  large  proportion  of  incombustible 
waste  material  which  the  liver  and  kidneys  are  called  upon  to  excrete, 
putting  extra  exertion  on  these  organs.  If  this  large  amount  of  protein 
is  unnecessary,  it  is  not  a  very  far  step  to  the  assumption  that  it  must 
be  injurious,  because  a  considerable  amount  of  energy  must  be  devoted 
to  catabolism  in  the  cells  and  to  the  excretion  of  its  waste  products  by 
the  kidney,  energy  which  might  otherwise  be  utilized  and  assist  in 
metabolism  of  the  muscles. 

PROTEIN  STRUCTURE  AND  PROPERTIES 

Chemical  Formation  of  Protein  Fractions. — It  is  an  established  fact  that 
proteins  are  the  actual  vehicles  of  life  and  upon  their  properties  the  very 
possibilities  of  life  depend.  The  huge  molecules  of  the  proteins  have 
been  teased  and  torn  out — to  borrow  a  term  of  histology — and  as  a 
result  the  conception  of  an  unwieldy  group  of  atoms  has  been  replaced 


PROTEIN    STRUCTURE    AND    PROPERTIES  199 

by  that  of  an  orderly  structure  composed  of  comparatively  simple  build- 
ing stones,  forming  a  neatly  constructed  block  of  masonry  rather  than 
an  amorphous  mass  of  concrete.  These  building  stones  are  now  famil- 
iarly known  as  protein  fractions.  Some  of  them  have  long  been  known 
as  rare  ingredients  of  the  excreta — such,  for  instance,  as  tyrosin,  leucin 
and  cystin — but  whence  they  came  and  how  they  were  formed  in  the 
body  has  been  until  recently  unknown.  Widely  as  the  protein  fractions 
differed  in  their  structure,  they  have  this  in  common:  they  are  amino- 
or  di-amino-acids,  and  share  the  properties  of  acids  and  bases.  They 
are,  furthermore,  capable  of  combining  with  each  other  to  form  compli- 
cated chains  or  networks  which  constitute  the  protein  molecules,  and 
since  they  admit  of  combination  into  many  different  groupings  there 
is  a  possibility  of  almost  infinite  varieties  of  protein  structure. 

QUANTITATIVE  DIFFERENCES  OF  PROTEINS.— A  great  deal  of  OUr 
newer  information  concerning  the  proteins  we  owe  to  Osborne  and 
Mendel  (37).  They  have  experimented  with  pure  proteins  and  they 
have  shown  definitely  that  certain  amino-acids  are  indispensable  in  food. 
With  certain  proteins — lacking  certain  of  the  amino-acids — maintenance, 
but  not  growth,  occurs.  With  other  proteins  deficient  in  certain  other 
amino-acids,  not  even  equilibrium  can  be  maintained.  For  instance, 
they  have  shown  that  the  protein  of  com  (zein)  is  an  inefficient  protein, 
and  that  when  zein  serves  as  the  sole  source  of  nitrogen  in  the  diet, 
nutritive  failure  results.  It  is  a  perfectly  digestible  protein,  but  lacks 
tryptophan  and.  lysin.  Likewise,  gelatin  does  not  contain  tryptophan, 
an  amino-acid,  which  is  essential  for  the  maintenance  of  the  body  nutri- 
tion. The  addition  of  both  of  these  latter  to  zein  cortipletes  it.  Add 
tryptophan  alone,  and  equilibrium  is  maintained.  Add  both,  and  growth 
follows.  Glutelin  of  corn  is  a  complete  protein,  but  it  does  not  occur 
in  sufficient  quantity  to  balance  the  deficient  zein^  therefore  corn  is  not 
a  complete  protein.  Other  proteins  which  are  relatively  poor,  though 
not  entirely  lacking  in  certain  amino-acids  necessary  for  growth,  are 
gliadin  of  wheat  and  hordein  of  barley.  To  this  class  also  belong  the 
protein  of  hemp  seed,  edestin,  which  is  comparatively  poor  in  lysin. 
Wheat  gliadin  will  serve  to  maintain  equilibrium,  but  will  not  permit 
of  growth.  Add  lysin  to  gliadin,  however,  and  growth  results.  Gliadin 
is  evidently  a  better  source  of  nitrogen  than  zein.  Lysin  is  present  in 
many  foods;  for  instance,  0.0  per  cent  in  lactalbumin,  7.59  per  cent  in 
ox  muscle,  4.81  per  cent  in  the  yolk  of  eggs,  4.08  per  cent  in  peas,  4.58 
per  cent  in  beans,  7.61  per  cent  in  casein.  The  addition  of  any  of  these 
to  a  corn  or  wheat  dietary  adds  to  its  efficiency  and  tends  to  insure 


200  PROTEIN   AND    NUTRITION 

growth.  These  facts  apply  to  adult  animals,  but,  to  be  sure,  they  also 
apply  more  trenchantly  to  young  animals. 

The  energy  value  of  gelatin  is  inferior  to  protein  for  growth  and 
repair.  It  is,  however,  a  true  protein,  though  not  complete,  and,  there- 
fore, gelatin  alone  cannot  maintain  protein  equilibrium  in  nutrition. 
The  "incompleteness"  of  food  value  is  doubtless  due  to  the  absence  of 
certain  amino-acid  radicals,  conspicuously  tryptophan,  in  the  gelatin 
molecule.  Gelatin  alone  would  not  supply  the  necessary  protein  content 
of  a  well-regulated  dietary.  If  one  were  to  rely  largely  on  gelatin  as 
a  food  it  would  be  necessary  to  add  other  proteins,  such  as  those  of  milk, 
rich  in  particular  amino-acids  which  gelatin  lacks. 

QUALITATIVE  VARIATIONS  IN  THE  AMINO-ACIDS  OF  PROTEINS.— 
In  the  table,  Volume  I,  Chapter  III,  are  clearly  shown  the  variations  to 
be  found  in  several  of  the  typical  proteins.  The  most  marked  differences 
in  amino-acids  from  a  quantitative  point  of  view  are  very  definite.  Again, 
considered  from  the  qualitative  standpoint,  variations  in  nutritive  value 
are  very  important.  The  mention  of  a  few  of  the  most  striking  variations 
may  serve  to  make  this  point  more  clear.  Albumin  and  casein  contain 
no  glycocoll ;  gliadin  derived  from  wheat  is  also  glycocoll-free  and  contains 
only  a  negligible  trace  of  lysin ;  zein  derived  from  corn  contains  neither 
lysin  nor  tryptophan;  and  gelatin  has  no  tryptophan,  tyrosin  or  cystin. 
Munk  and  Voit,  in  their  well-known  work,  were  the  first  to  emphasize  the 
bearing  of  the  qualitative  variations  in  protein  from  the  viewpoint  of 
nutritive  value,  especially  as  regards  gelatin,  which  they  proved  could  not 
sustain  nitrogen  equilibrium.  Escher  showed  that  the  addition  of  tyrosin 
to  gelatin  increased  its  value  to  the  point  of  establishing  nitrogenous 
equilibrium.  This  work  constitutes  the  introduction  to  a  series  of  experi- 
ments which  have  done  much  to  solve  many  puzzling  problems  associated 
with  the  metabolism  of  nutrition.  It  is  not  the  purpose  of  this  work  to 
enter  into  the  details  of  all  these  experiments,  but  a  glance  will  be  given 
to  the  more  important. 

Kaufman  demonstrated  that  gelatin  with  the  addition  of  the  missing 
amino-acids,  t^TOsin  and  tryptophan,  is  capable  of  maintaining  nitrogen 
equilibrium  for  short  periods  in  man  and  dogs.  Willcock  and  Hop- 
kins(38)  report  most  interesting  experiments  with  zein,  which,  as  has 
been  said,  is  deficient  in  lysin  and  tryptophan.  Light  from  new  angles 
is  thrown  on  the  problem  under  consideration  and  the  results  accord 
perfectly  with  the  most  recent  theories.    According  to  these  investigators : 

We  are  no  longer  bound  to  Liebig's  view,  or  to  any  modification  of  it  which 
Implies  that  the  whole  of  the  protein  consumed  is  utilized  as  intact  protein;  nor 


PROTEIN    STRUCTURE    AND    PROPERTIES  201 

are  we  even  compelled  to  assume  tliat  the  whole  of  what  is  broken  down  in  the 
gut  is  resynthesized  before  utilization.  Protein  products  may  function  in  other 
ways  than  in  the  repair  of  tissues  or  in  supplying  energy.  It  is  highly  probable 
that  the  organism  uses  them,  in  part,  for  more  specific  and  more  immediate  needs. 
The  discovery  of  substances  absolutely  essential  to  life,  highly  specific,  and  elabo- 
rated in  special  organs,  suggests  that  some  part,  at  least,  of  the  protein  products 
set  free  in  the  gut  may  be  used  directly  by  these  organs  as  precursors  of  such 
specific  substances.  In  adrenalin,  for  instance,  we  have  an  aromatic  substance 
absolutely  essential  for  the  maintenance  of  life,  and  it  is  probable  that  the  supra- 
renal gland  requires  a  constant  supply  of  some  one  of  the  aromatic  groups  of  the 
protein  molecule  to  serve  as  an  indispensable  basis  for  the  elaboration  of  adrenalin. 
If  this  be  so,  it  is  certain  that  the  gland  itself  could  not,  in  starving  animals, 
supply  sufficient  of  such  a  precursor  to  outlast  the  observed  survival  periods. 
Since  adrenalin  must  be  produced  at  all  costs,  the  required  precursor  must,  in 
starvation,  be  obtained  by  tissue  breakdown  outside  the  gland.  We  may  be  sure, 
however,  that  adrenalin  is  far  from  being  the  only  substance  elaborated  to  which 
such  considerations  apply.  Similarly,  in  an  animal  upon  a  diet  sufficient  to  supply 
energy,  but  lacking  in  some  essential  group,  the  minimal  waste  in  the  general 
tissues  of  the  body  will  be  determined  by  the  special  need  of  the  organs  for  the 
missing  group.  On  this  basis  we  have  a  hypothesis  to  account  for  the  special 
protein-sparing  properties  of  gelatin.  It  shares  with  protein  certain  molecular 
groupings  needed  to  satisfy  specific  needs,  and  is  thus  superior  to  fats  and  carbo- 
hydrates as  a  protein  sparer;  it  lacks,  on  the  other  hand,  certain  necessary  group- 
ings, fails  therefore  to  supply  all  such  needs,  and  thus  cannot  replace  protein. 

Physical  Properties  of  Proteins. — In  the  process  of  metabolism,  the 
role  of  the  proteins  is  fast  becoming  the  role  of  the  aminq-acids.  The 
body  metabolism  makes  use  of  amino-acids,  but  the  human  economy 
must  be  fed  proteins  from  which  the  amino-acids  are  derived,  and  they 
depend  in  amount  not  only  upon  the  chemical  composition  of  the  pro- 
tein, but  n])on  its  ]i]iysical  oliaraetor  and  also  upon  other  substances 
combined  or  mixed  with  tlie  alimentation.  It  has  long  been  thought 
that  the  proportion  of  ingested  protein  that  is  digested  and  absorbed 
from  bread  varies  according  to  the  amount  of  the  outer  cortex  (bran) 
of  the  grain  present  in  the  flour,  less  being  absorbed  from  bread  made 
from  the  coarser  meals  and  flours;  that  the  percentage  of  cellulose  in 
other  foods  also  has  a  bearing  on  the  absorption  of  protein. 

It  has  been  shown  by  Hart  and  McCollum(39)  that  the  inadequacy 
of  corn  as  an  exclusive  food  is  due  partly  to  the  character  of  its  proteins, 
partly  to  the  deficient  mineral  content.  When  these  deficiencies  are  sup- 
plied, normal  growth  is  possible  on  a  dietary  composed  largely  of  com. 

In  order  to  understand  clearly  the  role  of  proteins  in  growth  from 
the  standpoint  of  the  sources  of  our  food,  it  is  necessary  to  appreciate, 
first,  that  the  utilization  of  proteins  depends  on  the  characteristics  of 


202  PEOTEIIT   AND    :NtUTRITIO:N' 

the  proteins  themselves  or  of  the  foods  containing  them,  which  make 
them  resistant,  and  not  to  the  digestive  enzymes  and  hormones,  which 
influence  the  rate  of  their  passage  through  the  alimentary  canal;  second, 
their  digestion  and  assimilation:  to  what  extent  they  can  supply  the 
essential  amino-acids  in  the  proportion  in  which  the  body  requires  them 
for  the  wear  and  tear  and  tissue  building;  and  third,  the  physiological 
effect  of  individual  amino-acids,  especially,  perhaps,  those  furnished  by 
the  proteins  in  question  in  excess  of  the  body  needs (40). 

RELATIVE  ABSORPTION  OF  PROTEINS.— The  experiments  of  Mendel 
and  Fine  (41),  recently  confirmed  by  the  findings  of  Howe  and 
Hawk  (42),  show  that  when  fed  in  a  more  or  less  isolated  form,  the 
proteins  of  cereals  are  as  completely  digested  and  absorbed  as  the  pro- 
teins of  animal  food — 91-97  per  cent;  but  for  the  proteins  fed  in  the 
natural  food  these  values  do  not  hold.  Only  80-85  per  cent  of  the  nitro- 
gen of  wheat  bread  is  absorbed,  70  per  cent  of  rye,  58  per  cent  of  pum- 
pernickel, 40.76  per  cent  barley  and  61-82  per  cent  of  corn  nitrogen. 
These  percentage  values,  showing  the  amount  of  protein  absorbed  from 
whole  grain  cereals,  were  determined  by  methods  less  accurate  than  those 
now  in  use,  but  they  serve  to  show  the  comparable  absorption  of  proteins 
from  different  cereals,  and  show  undoubtedly  lower  protein  utilization 
in  grains  than  in  isolated  grain  proteins. 

DIFFERENCES  IN  SUITABILITY  FOR  TISSUE  CONSTRUCTION.— 
"With  equal  digestion  and  absorption,  proteins  may  still  differ  greatly 
in  their  suitability  for  tissue  construction  and  otherwise  in  their  physio- 
logical effect."     According  to  Howe  and  Hawk: 

The  proteins  of  meat  and  of  the  commercial  wheat  preparation,  gliadin,  are 
about  equally  well  digested  and  absorbed,  but  when  fed  for  a  period  of  Ave  days 
in  equal  qiuintity  and  in  similar  rations,  gliadin  gave  a  negative  nitrogen  balance 
of  1.3  grams,  while  meat  gave  a  positive  balance  of  11.3  grams. 

Osborne  and  Mendel  have  shown  that  a  large  number  of  proteins 
contain  all  the  amino-acids  necessary  for  growth :  ovo-albumin,  ovo- 
vitellin glutenin,  maize  glutelin,  edestin,  casein,  lactalbumin.  Hart  and 
McCollum(43)  and  their  co-workers  have  found  several  natural  mixtures 
of  proteins  occurring  in  wheat,  corn,  oats  and  milk  which  furnish  the 
amino-acids  requisite  for  tissue  construction.  McCollum,  in  comparing 
the  protein  mixtures  of  the  grains  previously  enumerated,  with  one 
another  and  with  the  protein  mixture  of  milk  to  determine  their  avail- 
ability for  growth,  found  the  available  nitrogen  of  cereals  to  be  23-24 
per  cent,  45  per  cent  casein  nitrogen  and  63  per  cent  of  milk  nitrogen 


THEORIES    OF    PROTEIN    METABOLISM  203 

fed  as  milk.  It  is  evident,  therefore,  that  the  amiiio-acids  resulting 
from  the  digestion  and  assimilation  of  milk  proteins  not  only  contain  all 
the  units  necessary  for  tissue  building,  but  contain  them  more  nearly 
in  the  proportion  in  which  they  can  be  used  than  is  the  case  with  the 
other  foods  considered.     Wheeler  says: 

If  there  is  a  shortage  of  one  amino-acid  essential  to  the  building  of  body  pro- 
tein, the  amount  of  that  acid  present  determines  not  only  the  amount  of  tissue 
construction,  the  rate  of  growth,  but  determines  also  the  proportion  of  the  food 
protein  that  can  be  used  for  growth.  It  has  been  found  that  the  body  metabolism 
can  store  very  little  reserve  amino-acid — practically  all  of  the  amino-acid  that 
cannot  be  built  into  protein  is  promptly  deaminized  and  the  nitrogen  excreted. 

The  investigations  of  Osborne  and  Mendel  (44)  have  thrown  light 
on  the  nutritive  value  of  individual  amino-acids:  the  aromatic  aniino- 
acids  are  essential  to  maintenance;  cystin,  lysin,  probably  arginin,  and 
histidin  are  essential  for  growth.     Again  Wheeler  says: 

An  understanding  of  the  role  exerted  by  the  individual  amino-acids  in  metab- 
olism suggests  wonderful  possibilities,  for  in  the  future  it  will  be  possible  for 
the  physician  or  dietitian  to  feed  a  frail,  undersized  child  on  just  the  right  com- 
bination of  milk,  eggs  and  cereals  to  furnish  the  amino-acids  he  needs,  in  the  right 
proportion,  with  no  large  excess  of  any  one  to  overtax  the  excretory  system  or  to 
overstimulate  metabolism;  a  worn-out  neurasthenic  can  be  given  just  the  right 
amino-acids  to  replace  worn-out  tissue  and  enough  glycocoll  to  stimulate  metabolism. 

Enough  has  been  drawn  from  the  writings  of  Osborne,  Mendel, 
Howe,  Hawk  and  others  to  make  us  feel  the  importance  of  knowing  the 
protein  composition  of  foods  and  how  to  mix  them  in  order  to  obtain 
a  sufficient  quantity  of  complete  protein.  It  is  evident  to  the  careful 
student  of  dietetics  that  there  is  but  one  general  way  in  which  to  for- 
mulate the  diet  question,  bearing  in  mind  the  fact  that  "a  man  who 
maintains  his  weight  may  be  in  excellent  nutritive  condition,  but  a  child 
who  does  the  same  thing  may  be  failing  to  grow" (45). 

THEORIES    OF   PROTEIN   METABOLISM 

After  weighing  all  the  discussions  pro  and  con  as  to  the  necessity 
for  protein  in  the  dietary,  we  come  to  the  conclusion  that  a  reasonable 
surplus  of  protein  from  suitable  food  materials  can  hardly  be  injurious, 
and  may  be  advantageous.  Whether  such  a  surplus  should  be  especially 
recommended  or  not  is  largely  a  question  of  economics.  Where  little 
money  can  be  spent  for  food  there  is  danger  that  too  little  food  may  be 
eaten,  and  it  should  be  remembered  in  suggesting  dietaries  that  protein 


204  PKOTEIN    AND    NUTRITION 

can  be  secured  from  beans,  peas,  etc.,  at  about  two-fifths  the  cost  of 
obtaining  it  from  porterhouse  and  sirloin  cuts  of  steak.  In  considering 
this  subject,  we  must  not  be  misled  by  the  popular  statement  that  ''pro- 
tein builds  tissue"  into  supposing  that  a  liberal  amount  of  protein  can 
keep  the  body  strong  in  spite  of  a  deficiency  in  the  total  food.  This 
impression  is  somewhat  general,  but  is  certainly  incorrect. 

From  investigations  of  Chittenden,  Fisher,  Peschel,  Hindhede  and 
others,  coupled  with  our  own  personal  experience,  we  find  that  physical 
strength  and  bodily  health  can  be  maintained  on  a  low  protein  diet,  but 
it  is  difficult  for  students  following  the  teaching  of  the  scientists  of  the 
old  school  to  rid  themselves  of  the  idea  that  there  must  be  "something" 
of  especial  value  in  meat.  It  would  seem  to  be  rather  difficult  to  express 
the  exact  truth  of  what  this  "something"  is.  We  know  that  this  "some- 
thing" has  nothing  to  do  with  health,  with  working  ability,  with  strength 
and  endurance;  it  is  energy. 

According  to  Hutchison  (46),  it  is  undoubtedly  possible  to  maintain 
a  healthy  life  upon  the  protein  contained  in  a  moderate  quantity  of 
vegetable  food,  and  the  accumulated  experience  of  vegetarian  races  fully 
bears  this  out: 

This,  however,  does  not  dispose  of  the  question.  There  is  such  a  thing  as 
degrees  of  health.  While  one  freely  admits  that  health  and  a  large  measure  of 
muscular  strength  may  be  maintained  upon  a  minimum  daily  supply  of  protein, 
yet  I  think  that  a  dispassionate  survey  of  mankind  will  show  that  races  which 
adopt  such  a  diet  are  lacking  in  what,  for  want  of  a  better  word,  one  can  only 
describe  as  energy.  Now,  energy  is  not  to  be  confused  with  muscular  strength. 
A  grass-fed  cart  horse  is  strong;  a  corn-fed  hunter  is  energetic.  Energy  is  a 
property  of  the  nei-vous  system;  strength,  of  the  muscles.  Muscles  give  us  the 
power  to  do  work;  the  nervous  system  gives  us  the  initiative  to  start  it.  Muscles 
do  their  work  upon  carbohydrates,  which  are  the  characteristic  nutritive  con- 
stituent of  vegetable  foods ;  the  brain  appears  to  require  nitrogen,  which  can  only 
be  obtained  in  a  concentrated  form  from  animal  sources.  If  protein  food,  there- 
fore, be  regarded  as  a  nervous  food,  a  diet  rich  in  it  will  make  for  intellectual 
capacity  and  bodily  energy,  and  it  is  not  without  reason  that  the  more  energetic 
races  of  the  world  have  been  meat  eaters. 

It  should  be  stated  that  Hutchison's  theorizing  concerning  protein 
versus  nervous  energy  and  brain  work  is,  at  present,  simply  his  personal 
opinion,  not  formed  on  exact  observations.  Mental  work  exercises  no 
direct  influence  on  metabolism.  The  molecular  changes  which  are  char- 
acteristic and  lie  at  the  foundation  of  all  mental  processes  are  neither 
oxidation  nor  decomposition  processes,  or,  if  they  are,  they  are  too  slight 
in  degree  to  be  calculated  by  our  present  methods. 


THKOR1E8    OF    TKOTEIX    METABOLISM  205 

In  order  to  maintain  tlie  blood  and  muscles  in  a  good  physical  con- 
dition, an  abundant  supply  of  protein  seems  to  be  necessary,  and  by 
promoting  oxidation,  it  increases  vigor  and  diminishes  the  tendency  to 
an  undue  accumulation  of  fat.  The  nervous  system  also  requires  a 
plentiful  supply  of  protein,  if  those  mysterious  influences  which  emanate 
from  the  brain  and  spinal  marrow  are  to  be  maintained  with  sufficient 
potency  to  enable  the  tissues  to  ward  off  the  inroads  of  disease.  It  is 
claimed  that  persons  who  habitually  live  on  a  protein  minimum  con- 
valesce very  slowly  after  an  acute  illness,  for  the  reason  that,  when  their 
tissues  are  broken  down,  they  have  no  ready  surplus  of  building  mate- 
rial out  of  which  to  repair  them.  An  increase  in  protein  intake  pro- 
duces a  rise  in  protein  metabolism.  This  occurs  to  such  an  extent  that 
the  organism  is  generally  able  to  maintain  itself  in  nitrogenous  equi- 
librium on  the  most  diverse  amounts  of  protein.  This  coincides  with 
the  observation  of  von  Noorden  and  others,  that  the  body  is  unable  to 
store  any  excessive  amount  of  protein. 

These  two  observations  are  only  two  different  ways  of  stating  the  same 
fact.  At  first  sight,  the  fact  that  the  organism  is  able  to  break  down  as 
much  protein  as  is  conveyed  to  it,  appears  not  to  agree  with  the  law  that 
the  degree  of  protein  metabolism  varies  with  tissue  requirements  and  not 
with  the  amount  which  is  presented  to  the  cells.  The  law  is  absolutely 
true  so  far  as  the  consumption  of  oxygen-  and  nitrogen-free  substances 
is  concerned.  The  extraordinary  variations  in  protein  consumption, 
which  may,  with  a  rise  in  the  intake,  reach  to  ten  or  fifteen  times  the 
normal,  have  occasioned  much  uncertainty,  so  long  as  the  degi'ee  of  the 
metabolism  is  regarded  purely  from  the  standpoint  of  protein  metabolism. 

AYe  all  know  the  feeling  of  well-being  which  follows  a  meal  containing 
meat.  Physiologists  tell  us  that  this  condition  of  well-being  is  due  to  the 
protein  in  the  meat  and  not  to  its  extractives,  as  it  has  been  demonstrated 
that  the  addition  of  extractives  of  meat  to  foods,  such  as  bread,  will  not 
produce  this  feeling  of  contentment  and  well-being.  On  the  other  hand, 
oatmeal,  which  is  rich  in  protein,  is  capable  of  bringing  about,  to  a  cer- 
tain extent,  this  degree  of  well-being.  A  full  meal  of  nitrogenous  food 
is  an  actual  stimulant  to  the  tissues  of  the  body. 

It  has  to  be  remarked  concerning  animal  food  that,  while  in  the  raw 
state,  it  may  be  readily  digestible  with  little  or  no  previous  mastication, 
since  massive  pieces  of  it  are  readily  attacked  by  the  digestive  juices, 
this  is  much  less  true  of  animal  food  the  proteins  of  which  have  been 
coagulated  and  rendered  less  permeable  by  cooking.  Yet  the  most  indi- 
gestible form  of  egg  white  is  the  raw  liquid  albumen ;  it  resists  digestion 


206  PKOTEIN    A:N^D    NUTRITION 

so  much  that  even  a  dog  can  utilize  onlj  50  per  cent  of  the  nitrogen,  the 
balance  being  excreted  in  the  feces.  Large  lumps  of  hard-boiled  egg  or 
overdone  meat  may  obstinately  resist  gastric  digestion — indeed,  the  rela- 
tive digestibility  of  animal  foods  depends  more  upon  physical  consistence 
than  chemical  composition ;  beef  is  generally  more  indigestible  than  mutton, 
and  pork  or  veal  than  either,  not  so  much  by  virtue  of  chemical  compo- 
sition as  of  physical  consistence. 

Americans  are  said  to  be  the  greatest  meat  eaters  in  the  world.  The 
average  American  feels  that  he  must  have  meat  at  least  twice  a  day,  and 
.  not  a  few  of  them  are  dissatisfied  if  they  do  not  have  some  form  of  meat 
at  every  meal.  That  this  excessive  meat  consumption  is  injurious  to  a 
great  many  people,  and  especially  to  those  living  sedentary  lives,  is  attested 
by  the  clinicians  who  are  called  upon  to  treat  disturbances  in  nutrition 
and  metabolism.  That  a  heavy  meat  diet  is  not  necessary  is  amply 
demonstrated  by  the  experience  of  the  Japanese  soldiers  in  the  war  between 
Russia  and  Japan (47),  and  is  being  demonstrated  at  the  present  time  in 
the  European  war,  where  the  soldiers  have  been  forced  to  accept  a  diet 
that  is  almost  wholly  vegetarian.  The  testimony  of  those  who  are  familiar 
with  conditions  seems  to  indicate  that  the  soldiers  are  much  better  off  on 
the  vegetable  diet  than  they  were  when  they  obtained  a  liberal  supply  of 
animal  food.  May  we  not  learn  a  lesson  from  the  experiences  of  the 
European  soldiers  which  were  brought  about  by  force  of  necessity? 

We  believe  it  good  advice  to  direct  a  liberal  allowance  of  meat  up  to 
middle  life,  or,  to  be  more  exact,  to  the  thirtieth  year,  when  it  is  no  longer 
necessary  to  have  an  alimentation  for  building  more  tissues  or  to  promote 
growth,  but  only  to  maintain  an  equilibrium  of  weight  and  strength. 
From  thirty  to  the  thirty-fifth  year  a  man  should  begin  to  restrict  his 
meats ;  after  thirty-five  he  should  partake  of  meats  less  freely,  more  espe- 
cially the  red  meats ;  after  forty-five  he  should  eat  meats  sparingly ;  after 
fifty  he  should  only  eat  very  small  portions  of  meat  once  a  day.  We  are 
satisfied  that  the  American  people  would  be  better  off  by  far  if  they  had 
50  per  cent  of  the  protein  eliminated  from  the  daily  alimentation. 

Man  at  maturity — the  thirtieth  year — from  habits  formed  in  early 
life,  habitually  eats  too  much.  The  wholesome  appetite  of  healthy  child- 
hood is  strongly  established  and  the  pleasure  of  eating  has  become  a 
habit  as  fixed  and  inviolable  as  the  "laws  of  the  Medes  and  Persians." 
Therefore,  most  men  and  women  are  inclined  to  eat  too  much  and  too 
rich  food  that,  although  palatable,  is  indigestible.  It  is  at  this  time 
that  indiscretions  of  diet  are  most  frequently  the  cause  of  disorders  of 
digestion  and  assimilation.     It  is  without  question  that  we  would  be 


THEORIES    OF    PROTEIN    METABOLISM  207 

satisfied  with  less  nliinent  and  more  particularly  much  less  protein  than 
we  have  been  accustomed  to  ingest. 

At  this  time  of  life  the  habit  of  only  eating  what  is  needed  should 
be  acquired  and  the  earlier  habits  of  life  should  be  broken.  The  average 
man  should  limit  himself  to  small  portions  and  should  make  it  a  rule 
not  to  have  the  second  helping  of  any  kind  of  food  at  a  meal.  This 
general  rule  is,  of  course,  subject  to  modification,  for  individuals  en- 
gaged in  strenuous  occupations  require  a  somewhat  more  liberal  dietary 
allowance  containing  the  ternary  food  elements.  General  practitioners 
in  agricultural  districts  frequently  observe  that  farmers,  during  the 
summer,  when  their  occupation  is  most  strenuous,  eat  very  heartily. 
Their  work  in  the  open  enables  them  to  consume  and  digest  large  amounts 
of  food.  Unfortunately,  during  the  winter  months,  when  their  work  is 
comparatively  light,  they  continue  the  same  habit  and  spend  too  much 
time  at  the  table  and  consume  an  inordinate  amount  of  food  as  com- 
pared with  their  activities.  Such  indiscretions  at  first  cause  slight  gas- 
tric disturbances,  but  later  on  chronic  digestive  disorders  will  result. 

We  have  a  suspicion  that  a  vast  number  of  ailments  and  disorders 
of  the  stomach,  nerves,  liver  and  kidneys,  not  to  mention  gout,  are  to 
be  attributed  simply  to  the  overfeeding  on  meats.  In  the  past,  when 
these  dyspeptic  and  nerve-weary  patients  presented  themselves,  complain- 
ing of  drowsiness,  debility,  general  disgust  with  life,  etc. — all  due  to  the 
ingestion  of  too  much  protein — how  often  has  the  physician  exhorted 
them  to  eat  plentifully !  Worse  advice  could  not  have  been  given.  Chit- 
tenden, formerly  a  believer  in  a  high  protein  diet,  and  particularly  in 
meat,  has  lately  seen  the  error  of  the  older  views,  and  now  believes  in 
and  teaches  a  low  protein  diet.  Accordingly,  body  weight,  health, 
strength,  mental  and  physical  vigor  and  endurance  can  be  maintained 
with  at  least  one-half  of  the  protein  food  ordinarily  consumed;  a  kind 
of  physical  economy  which,  if  once  entered  into  intelligently,  entails  no 
hardships,  but  brings  with  it  an  actual  betterment  of  the  physical 
strength,  increased  endurance,  greater  freedom  from  fatigue,  and  a  con- 
dition of  well-being  that  is  full  of  suggestion  for  the  betterment  of 
health. 

Whether  the  fatigue  poisons  come  from  the  excessive  exogenous 
catabolism  of  proteins  in  general,  or  whether  they  are  derived  directly 
in  a  measure  from  flesh  foods,  need  not  be  considered  here;  the  main 
point  is  that  by  lowering  the  rate  of  protein  catabolism,  which  neces- 
sarily compels  a  reduction  in  the  amount  of  flesh  foods,  there  is  a 
diminished  quantity  of  nitrogen  waste  floating  about  in  the  body.     Fur- 


208  PEOTEIX    A^'D    NUTRITION 

tlier,  we  need  not  criticize  too  closely  the  method  by  which  the  reduction 
of  food  is  accomplished :  whether  it  be  by  encouraging  prolonged  mas- 
tication, with  a  view  to  better  tasting  and  fuller  enjoyment  of  the  food, 
to  the  point  of  involuntary  swallowing;  or  whether  it  be  by  advising 
our  patients  to  follow  natural  impulses,  mastication,  taste  and  appetite 
reenforced  by  the  use  of  reason  with  a  full  appreciation  of  the  principle 
that  the  welfare  of  the  body  is  best  subserved  by  a  quantity  of  food  com- 
mensurate with  true  physiological  needs. 

According  to  writers  on  dietetics,  one  principle  in  sitology  which, 
has  not  received  adequate  recognition  may  be  summed  up  as  follows: 
"The  dietary  standard  varies  not  only  with  the  condition  of  activity, 
but  also  with  the  nutritive  plane  at  which  the  body  is  to  be  maintained." 
One  may  ask  the  question  then,  "What  level  of  nutrition  is  most  advan- 
tageous 'i"  The  answer  is  not  easy,  and  it  must  be  sought  in  metabolism 
experiments  and  dietary  studies;  and  it  must  also  be  sought  in  broader 
observations  regarding  bodily  and  mental  efficiency,  general  health, 
strength  and  welfare. 

According  to  the  earlier  views,  the  protein  is  built  up  from  peptone 
through  synthesis  in  the  wall  of  the  intestine,  since  no  other  tissue  in  the 
body  has  the  power  of  causing  peptone  to  disappear.  Conheim  teaches 
that  the  peptone  molecules  vanish  not  because  they  are  built  up,  but 
because  they  are  broken  down.  The  site  of  this  synthesis,  according  to 
his  opinion,  is  still  uncertain,  though  he  holds  to  the  belief  that  the 
intestinal  wall  is  where  protein  synthesis  begins.  If  a  complete  syn- 
thesis of  protein  does  take  place  in  this  intestinal  wall,  it  must  be  a 
neutral  protein,  that  is,  one  that  is  found  in  the  blood.  We  can  hardly 
conceive  of  the  intestine  synthesizing  and  delivering,  in  obedience  to 
reflex  demands  of  the  various  organs  of  the  body,  just  the  particular 
variety  of  protein   (amino-acids)   that  is  needed. 

Lewis  once  taught  that  protein  was  built  up  from  the  fragments  of 
the  food-protein  molecule,  not  in  the  wall  of  the  intestine,  but  in  the 
various  organs  of  the  body.  If  his  theory  is  correct,  then  the  blood 
would  carry  molecular  complexes  of  the  lower  orders  from  the  intestine 
to  the  organs  sufficient  for  their  local  necessities,  where  these  complexes 
would  be  built  up  into  the  protein  of  the  organs  in  situ,  without  having 
to  pass  through  the  preliminary  stage  of  conversion  into  neutral  protein. 
Von  Noorden  does  not  agree  with  this  supposition,  and  holds  that  the^ 
organism  is  certainly  able  to  convert  even  specific  varieties  of  the  pro- 
tein of  the  organs  into  other  kinds,  and  therefore  would  be  able  to  build 
up  organ-protein  out  of  neutral  protein. 


THEORIES    OF    PROTEIN    METABOLISM  209 

Beyond  question,  if  the  organism  is  able  to  interchange  the  proteins 
of  the  tissues,  which  are  distinctly,  though  slightly,  ditFerentiated,  one 
can  well  believe  that  it  has  the  power  to  build  tip  specific  kinds  of  pro- 
tein out  of  the  neutral  protein  of  the  blood.  Through  this  physio- 
metabolic  process,  the  intestine  would  then  hand  on  just  half -manufac- 
tured stuff  made  up  out  of  the  raw  materials  it  received,  but  the  organs 
would  perfect  the  work  and  produce  the  finished  article. 

We  have  seen,  from  the  study  of  protein  metabolism,  that  hydrolytic 
cleavage  precedes  every  metabolic  transformation  of  protein  inside  the 
body.  This  decomposition  goes  on  in  much  the  same  way  as  it  does  in 
the  protein  of  the  nourishment  in  the  intestine.  In  the  metamorphosis 
of  protein,  decomposition  would  only  be  excluded  supposing  that  it  con- 
sisted exclusively  in  the  annexing  of  new  groups — in  a  growth  of  the 
molecule.  "^'The  'living  molecule'  of  protein  in  protoplasm,  as  the  bearer 
of  life,  the  agent  and  instigator  of  all  body  chemical  changes,  has  to 
enter  into  a  temporary  alliance  with  the  lifeless  combustible  substances, 
the  dispensers  of  energy,  in  order  to  initiate  and  carry  through  their 
oxidation,  thus  transferring  to  itself  as  living  force  their  potential 
energy.  Thus  its  composition  must  vary  at  different  moments  according 
to  whether  it  has  just  annexed  such  combustible  substances  in  order  to 
oxidize  them,  or  has  just  given  them  off  again  after  the  combination." 

If  the  accepted  theory  be  that  protein  is  not  absorbed  in  the  form 
of  peptone  or  proteoses,  the  query  arises,  "In  what  form  is  it  absorbed  ?" 
If  it  is  admitted  that  protein  invades  the  blood  stream  in  the  form  of 
a  molecule  larger  than  the  amino-acids,  proteose  or  peptone  molecule,  it 
is  self-evident,  according  to  TJnderhill  of  Yale(48),  that 

The  intestine  must  be  regarded  as  capable  of  synthesizing  amino-acids  into 
protein.  On  the  other  hand,  if  amino-acids  are  regularly  present  in  the  systemic 
circulation,  the  place  of  protein  regeneration  must  be  relegated  to  the  cellular 
elements  of  the  different  tissues. 

Further : 

The  belief  now  generally  accepted,  as  regards  the  protein  requirements  of  the 
organism,  is  that  it  is  not  so  much  the  actual  quantity  as  the  quality  of  the  pro- 
tein supplied  in  the  food  which  is  of  importance.  If  the  material  supplied  be 
uniform,  it  necessitates  a  fresh  breakdown  by  each  tissue,  perhaps  by  each  indi- 
vidual cell.  Although  the  tissues  all  probably  possess  the  power  of  breaking  down 
protein  material  by  means  of  their  intracellular  proteolytic  enzymes,  still  the  extra 
work  involved  seems  to  negative  the  immediate  resynthesis  hypothesis,  especially 
when  the  hypothesis  of  the  circulating  digestion  product  postulates  the  presence 
of  the  individual  food  material  in  the  blood. 


210  PROTEIX    AND    NUTRITION 

The  extensive  researches  of  Folin,  Denis,  Van  Slyke(49)  and  Myer, 
and  later  xlbderhalden,  have  definitely  proved  the  entrance  into 
the  blood  stream  of  the  amino-acids,  which  once  for  all  definitely  estab- 
lishes their  function — i.e.,  of  being  absorbed  by  the  tissues  without 
undergoing  any  immediate  chemical  change.  While  this  absorption  is 
rapid,  it  is  never  complete,  the  blood  always  containing  a  small  quantity 
of  amino-acids.  It  would  appear  from  this  that  there  is  an  equilibrium 
between  the  amino-acids  of  the  blood  and  of  the  tissues.  The  way  in 
which  the  amino-acids  are  taken  up  by  the  tissues  and  held  by  them  is 
still  an  unsettled  point. 

These  same  investigators,  in  later  researches,  sought  to  determine 
the  ultimate  fate  of  the  amino-acids  after  absorption  by  the  tissues,  and 
selected  the  changes  occurring  in  the  liver,  where,  after  absorption,  the 
amino-acids  rapidly  disappear.  TJnderhill  offers  several  explanations 
and  suggests  the  following  possibilities:  (a)  The  amino-acids  may  be 
excreted  through  the  bile;  (6)  they  may  be  transferred  to  other  tissues, 
though  this  is  highly  improbable,  since  none  of  the  other  large  organs 
show  any  great  avidity  for  amino-acids;  (c)  the  absorbed  amino-acids 
are  synthesized  into  body  protein  in  the  liver,  and  (d)  the  amino-acids 
are  deaminized  with  formation  of  urea  or  ammonia. 

The  amino-acids  disappear  more  rapidly  and  completely  from  the 
liver  than  from  other  organs,  such  as  the  kidney,  spleen,  pancreas  and 
intestine.  A  most  satisfactory  summary  of  this  whole  subject  has  been 
made  by  Van  Slyke  and  Myer (49),  which  we  give  below  in  their  own 
words : 

The  amino-acids,  with  perhaps  some  peptids  from  the  intestine,  enter  the  circu- 
lation from  which  they  are  immediately  absorbed  by  the  tissues.  The  power  to 
take  them  up  from  the  blood  stream  is  common  to  all  tissues,  but  is  limited.  The 
muscles  of  the  dog,  for  example,  reach  the  saturation  point  when  they  contain 
about  75  mgm.  of  amino-acid  nitrogen  per  100  grams.  The  liver,  however,  con- 
tinually desaturates  itself  by  metabolizing  the  amino-acids  it  has  absorbed,  and 
consequently  maintains  indefinitely  its  power  to  continue  removing  them  from  the 
circulation  so  long  as  they  do  not  enter  it  faster  than  the  liver  can  metabolize 
them.  When  the  entrance  is  unnaturally  rapid,  as  in  our  injection  experiments, 
or  when  the  liver  is  sufficiently  degenerated,  as  observed  clinically  in  some  patho- 
logical conditions,  the  kidneys  assist  in  removing  the  amino-acids  by  excreting 
them  unchanged.  Death  may  result  when  the  above  agencies  for  preventing  undue 
accumulation  of  protein  digestion  products  are  overtaxed.  In  regard  to  the  syn- 
thesis of  tissue  proteins,  it  appears  reasonable  to  believe  that,  since  each  tissue 
has  its  own  store  of  amino-acids,  which  it  can  replenish  from  the  blood,  it  uses 
these  to  synthesize  its  own  proteins. 


THE01UE8    OF    PKOTEIN    METABOLISM  211 

From  the  research  experiments  of  Van  Slyke  and  Myer  it  may  be 
assumed,  says   Underhill,  that 

(a)  The  amino-acids  serve  as  a  reserve  energy  supply,  Uke  glycogen,  or  as  a 
reserve  tissue-building  material.  In  either  case,  the  supply  would  fail  unless  con- 
stantly supplied  from  the  absorption  from  the  intestinal  wall.  (6)  The  amino- 
acids  are  intermediary  products  in  both  the  anabolism  and  the  catabolism  of  the 
tissue  proteins.  In  this  case  they  could  originate  not  only  from  absorbed  food 
products,  but  also  from  autolized  tissue  protein;  starvation  would  not  result  in  a 
disappearance  of  the  amino-acid  supply  of  the  tissues,  and  might  even  increase  it. 

In  order  to  determine  the  correctness  of  either  of  these  assumptions, 
Van  Slyke  and  Myer  carefully  analyzed  the  tissues  of  animals  in  vari- 
ous stages  of  nutrition  and  concluded  that  the  presence  of  free  amino- 
acids  in  the  tissues  hastened  rather  than  retarded  starvation. 

In  further  summarizing,  the  investigators  express  themselves  as 
follows : 

The  amino-acids  appear,  therefore,  to  be  intermediate  steps,  not  only  in  the 
synthesis,  but  in  the  breaking  down  of  body  proteins.  Otherwise,  in  order  to 
explain  their  maintenance  in  the  tissues  during  starvation,  one  would  be  forced, 
contrary  to  the  conclusions  of  all  experimental  work  on  the  subject,  to  assume  that 
they  are  inert  substances  lying  unchanged  for  long  periods,  even  when  most 
urgently  needed  to  build  tissue  or  to  supply  energy.  The  maintenance  of  the 
amino-acid  supply  by  synthesis,  from  ammonia  and  the  products  of  fats  or  car- 
bohydrates, seems  excluded.  The  supply  of  raw  material  in  the  form  of  fat  and 
carbohydrate  nearly  disappears  during  starvation,  and  the  ammonia  could  origi- 
nate only  from  broken-down  protein,  as  the  normal  store  of  ammonia  nitrogen  is 
only  a  fraction  of  that  of  free  ammonia  acids.  These  considerations,  and  the  self- 
evident  wasting  of  starved  tissues,  point  strongly  to  autolysis  as  the  main  source  of 
the  free  amino-acids  of  the  fasting  body. 

The  failure  to  increase  the  free  amino-acid  content  of  the  tissues  by  high  protein 
feeding  indicates,  furthermore,  that  when  nitrogen  is  retained  in  the  organism,  it 
is  not  to  an  appreciable  extent,  as  stored  digestion  products,  but  rather  as  body 
protein. 

From  the  foregoing  it  is  no  longer  questioned  that  the  amino-acids 
are  normally  absorbed  directly  into  the  blood  stream  from  the  intestinal 
epithelium  and  distributed  to  the  tissues,  and  that  each  tissue  rebuilds 
itself  from  the  mixture  of  amino-acids  thus  conveyed  to  it.  Any  excess 
is  changed  into  urea  and  carbonaceous  residues  by  a  process  of  deamina- 
tion.  Protein  material  catabolized  in  the  tissues  undoubtedly  undergoes 
a  series  of  hydrolytic  cleavages,  resulting  in  the  formation  of  amino- 
acids,  and  the  latter  meet  the  same  fate  as  those  produced  direct  from 
food  protein. 


212  PEOTEIN    AND    NUTKITIOi^ 

Vegetable  Protein. — There  is  a  prevalent  belief  that  vegetable  protein 
is  far  more  difficult  of  complete  digestion  than  are  albuminous  substances 
of  animal  origin,  such  as  fish,  flesh,  fowl,  milk  and  eggs.  The  popular 
belief  of  the  small  percentage  of  vegetable  protein  utilized,  which  is  not 
without  foundation,  has  furnished  a  strong  argument  against  the  vege- 
table propaganda.  Numerous  research  workers  have  determined  experi- 
mentally that  the  protein  content  of  some  vegetables,  particularly  the 
coarser  cereals  and  most  of  the  common  legumes,  is  very  poorly  absorbed. 

Atwater  and  Bryant  (50),  experimenting  along  these  lines,  gathered 
the  following  data : 

CHARACTER  OF  THE  DIET  AND  PROTEIN   CONTENT   UTILIZED 

Character  of  Dietary  Percentage  of  Protein 

Utilized 

Animal  Food 97  per  cent 

•  Cereals 85  " 

Legumes-  dried 78  " 

Vegetables .83  " 

Fruits 85  " 

Vegetable  Food 84  " 

Total  Foods 92  " 

There  are  several  factors  which  might  help  to  explain  why  the  nutri- 
ents of  certain  vegetable  foods  are  more  difficult  of  utilization  than  the 
same  elements  from  animal  foods:  (a)  The  low  nitrogen  content  of 
most  vegetable  foods  requires  their  ingestion  in  relatively  large  amounts ; 
(b)  this  increased  bulk  of  vegetable  food  with  its  high  cellular  content 
tends  to  hasten  its  passage  through  the  intestinal  tract,  and  thereby,  to 
a  certain  extent,  reduce  the  chances  for  complete  digestion  and  utiliza- 
tion. In  comparison  with  animal  foods  the  vegetable  foods  may  present 
an  unfavorable  texture,  especially  in  the  older  plants,  in  which  the  cell 
walls  may  be  quite  tough  and  even  supplemented  with  lignin. 

There  is  abundant  evidence  that  cellulose  is  not  digested  to  any  con- 
siderable extent  by  the  higher  animals.  Again,  the  vegetable  membranes 
are  not  always  readily  permeated  by  the  digestive  juices.  Therefore  it 
is  readily  understood  that  plant  cells  should  be  thoroughly  and  effectively 
comminuted  and  insalivated  as  a  preliminary  step  to  complete  digestion 
and  assimilation. 

We  must  not  conclude  from  the  foregoing  that  vegetable  proteins 
possess  any  inherent  resistance  to  complete  digestion  and  utilization  by 
the  human  organism.  Mendel  and  Fine(51)  have  shown  that  the  two 
characteristic  proteins  of  wheat,  gliadin  and  glutenin,  are  as  completely 
absorbed  and  utilized  as  the  nitrogenous  components  of  fresh  beef.     The 


THEORIES    OF    PllOTEIN    METABOLISM  213 

same  probably  holds  true  for  the  protein  content  of  barley,  and  to  a 
lesser  degree  for  the  proteins  of  corn.  It  is  regrettable,  however,  that 
no  such  reports  are  at  hand  for  the  isolated  proteins  of  the  legumes, 
beans,  lentils  and  peas. 

The  newer  knowledge  of  the  physiology  of  the  amino-acids  empha- 
sizes the  fact  that  each  food  product  ought  to  be  tested  on  its  own  merits 
before  any  final  pronouncement  as  to  its  availability  and  utilization  is 
made.  Therefore  it  will  be  seen  that  a  protein  may  be  readily  digestible, 
and  its  digestion  products  easily  absorbed  into  the  blood  stream;  and 
yet  such  a  protein  may  be  of  inferior  biologic  value  because  of  its  failure 
to  yield  all  the  amino-acids  necessary  for  the  nutritive  functions  of  tissue- 
growth  and  repair.  The  test,  to  be  conclusive,  must  be  furnished  by  a 
physiologic  experiment  rather  than  a  mere  chemical  analysis. 

VALUE  OF  WHITE  POTATO.— Hindliede( 52)  of  Copenhagen  was  the 
first  to  call  attention  to  the  physiologic  value  of  tlie  nitrogenous  content  of 
the  white  potato.  Its  richness  in  starch  has  been  long  recognized  and 
has  led  to  the  inclusion  of  the  potato  in  the  group  of  carbohydrate  foods. 
Hindhede's  research  experiments  were  conducted  on  men,  and  were  of 
sufficiently  long  duration — weeks,  rather  than  days — to  give  unusual  sig- 
nificance to  the  data  collected.  He  was  able,  with  white  potatoes  and 
oleomargarin  as  the  sole  ingredients  of  the  ration,  to  maintain  a  satis- 
factory nitrogen  balance. 

The  researches  of  Hindhede  have  recently  been  corroborated  by  Rose 
and  Cooper (53)  at  the  department  of  nutrition  of  Columbia  University. 
The  ration  for  their  research  experiments  consisted  of  white  potatoes 
and  clarified  butter.  Sufficient  quantity  was  allowed  to  furnish  the 
requisite  fuel  value  and  the  potatoes  furnished  all  but  0.1  per  cent  of 
the  total  nitrogen.  The  nitrogen  balance  was  maintained  for  seven  days 
on  a  total  nitrogen  intake  of  0.096  grams  per  kilogram.  This  report  is 
in  harmony  with  other  experiments  in  which  the  nitrogen  equilibrium 
has  been  maintained  on  potato  nitrogen  when  the  net  available  energy 
supply  was  from  0.04  to  0.08  grams  per  kilogram  of  body  weight,  and 
effectively  demonstrates  that  the  potato  is  a  source  of  energy  of  high 
nutritive  efficiency  in  spite  of  the  fact  that  only  63  per  cent  of  the  potato 
nitrogen  is  reported  to  be  in  the  form  of  protein. 

The  unusual  prominence  of  the  potato  as  a  food  both  in  Europe  and 
America  is  due  to  its  palatable  carbohydrate  content.  The  researches  of 
careful  investigators  now  emphasize  its  base  yielding  inorganic  compo- 
nents, and  point  out  its  useful  function  in  maintaining  the  acid  base 
equilibrium  of  the  body (54).  The  climax  is  now  reached  by  a  most 
114 


214  PROTEIX    AXD    NUTRITION 

favorable  report  on  the  high  biologic  value  of  the  nitrogenous  components 
of  a  food  that,  heretofore,  has  rarely  been  regarded  as  having  any  sig- 
nificance whatever  as  a  source  of  nitrogen. 


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37.  Osborne  and  Mendel.     J.  Biol.  Chem.,  1914;  Med.  Rec,  1914; 

J.  Am.  Med.  Assn.,  1914. 

38.  AViLLCocK  and  Hopkins.     J.  Physiol.,  vol.  xxxv,  p.  88,  1916. 

39.  Hart  and  McCollim.     The  Influence  on  Growth  of  Rations  Re- 

stricted to  the  Corn  or  Wheat  Grain,  J.  Biol.  Chem.,  1914,  19, 
373-397. 

40.  Wheeler.     Proteins  in  Growth,  Scientific  Monthly. 

41.  Mendel  and  Fine.    Utilization  of  the  Proteins  of  Wheat,  J.  Biol. 

Chem.,  1912,  10,  303;  Utilization  of  the  Proteins  of  Barley, 
ibid.,  p.  345. 

42.  Howe  and  Hawk.     Utilization  of  Individual  Proteins  as  Influ- 

enced  by   Repeated   Fasting,    Eighth   Int.    Cong,    of   Applied 
Chem.,  19,  145. 

43.  Hart  and  McCollum.    Influence  on  Growth  of  Rations  Restricted 

to  the  Corn  or  Wheat  Grain,  J.  Biol.  Chem.,  1914,  19,  373-397. 

44.  Osborne  and  Mendel.     Comparative  Nutritive  Value  of  Certain 

Proteins  in  Growth,  J.  Biol.  Chem.,  1915,  20,  351. 

45.     .     Carnegie  Inst.  Pub.,  1911,  p.  156. 

46.  Hutchison.     Foods  and  Dietetics,  p.  174,  London,  1911. 

47.  Lewis,  H.  Edwin.     Editorial,  Am.  Med. 

4S.     Underiiill.     The  Physiology  of  the  Amino-Acids. 

49.  Van  Slyke  and  Myer.     J.  Biol.  Chem.,  1912,  pp.  197  and  231. 

50.  Atwater  and  Bryant.     Rep.  Storrs  Agric.  Exper.  Station,  1899, 

p.  86. 


216  PROTEII^   AND    NUTRITION 

51.  Mendel,  L.  B.,  and  Fine,  M.  S.     Studies  in  Nutrition — (a)  The 

Utilization  of  the  Protein  of  Wheat,  J.  Biolog.  Chem.,  1911, 
vol.  X,  p.  303;  {h)  The  Utilization  of  the  Proteins  of  Barley, 
ibid.j  p.  339;  (c)  The  Utilization  of  the  Protein  of  Corn,  ibid., 
p.  345;  (d)  The  Utilization  of  the  Proteins  of  Legumes, 
ibid.,  p.  433 ;  (/?)  The  Utilization  of  the  Proteins  of  Cotton- 
seed, ibid.,  1912,  vols,  i,  ii  and  vi. 

52.  HiNDHEDE,  M.     Untersuchungen  iiber  die  Verdaulichkeit  der  Kor- 

toffeln,  Ztschr.  f.  phys.  u.  diatet  Therap.,  1912,  16. 

53.  Rose,  Maky  S.,  and  Cooper,  Lena  F.     The  Biological  Efficiency 

of  Potato  Nitrogen,  J.  Biol.  Chem.,  1917,  30,  201. 

54.  Blathekwick,  N.  R.     The  Specific  Role  of  Foods  in  Relation  to 

the  Composition  of  the  Urine,  Arch.  Int.  Med.,  Sept.,  1914, 
p.  409. 

BIBLIOGRAPHY 

Aemstkong.     The  Simple  Carbohydrate  and  the  Glucosides. 

Atwater.  Methods  and  Results  of  Investigations  on  the  Chemistry  and 
Economy  of  Food. 

and  Benedict.      Comparison  of  Fats  and   Carbohydrates   as 

Protectors  of  Body  Material,  U.  S.  Dept.  of  Agric,  Office  of  Exper. 
Stations,  Bull.  136,  pp.  176-187. 

Benedict.  The  Influence  of  Inanition  on  Metabolism,  Carnegie  Institu- 
tion of  Washington,  Publication  No.  77. 

Catiicakt.     The  Physiology  of  Protein  Metabolism,  1912. 

Chittenden.  Physiological  Economy  in  Nutrition;  The  Nutrition  of 
Man. 

.     The  Nutrition  of  Man. 

FoLiN.    Am.  J.  Physiol.,  1905,  13,  p.  45. 

.     Intermediary    Protein    Metabolism,    J.    Am.    Med.    Assn., 

1914,  63,  p.  823. 
Glikin.     Chemie  der  Fette,  Lipoide,  und  Wachsarten. 
Hamimarsten.     Text-book  of  Physiological  Chemistry,  1914. 
Harper  and  Peter.     Protein  Content  of  the  Wheat  Kernel,  Kentucky 

Agric.  Exper.  Sta.,  Bull.  113,  1905. 
Kajiura.    The  Proteins  of  Rice,  Biochem.  J.,  1912,  vol.  vi,  pp.  171-181. 
LiEBiG.     Complete  Works  on  Chemistry,  1856. 


BIBLIOGRAPHY  217 

Li'SK.     Elements  of  the  Science  of  Nutrition. 

.     Elements  of  the  Science  of  Nutrition. 

Mendel.      Theorien  des  Eiweissstotfwechsels  nebst  einigen  praktischen 

Konsequenzen  derselben.     Ergebn.  d.  Physiol.,  1911,  11,  p.  418. 
and  Fink.     The  Utilization  of  the  Proteins  of  Corn,  J.  Biol. 

Chem.,  1911,  vol.  x,  pp.  345-352. 
.     The  Utilization  of  the  Proteins  of  Wheat,  ihid., 


pp.  303-325. 
Osborne.     The  Vegetable  Proteins. 

and  Mendel.     Nutritive  Properties  of  Proteins  of  the  Maize 

Kernel,  J.  Biol.  Chem.,  1914,  vol.  xviii,  pp.  1-16. 

.  Amounts  and  Properties  of  the  Proteins  of  the  Maize  Ker- 
nel, J.  Am.  Chem.  Soc,  1897,  vol.  xix,  pp.  525-532. 

.     The  Nutritive  Value  of  the  Proteins  of  Maize,  Science,  Jan. 

31,  1913,  vol.  xxxvii,  pp.  185-191. 

and  Mendel.     Feeding  Experiments  with  Isolated  Food  Sub- 


stances. 
Plimmer.     The  Chemical  Constitution  of  the  Proteins. 
SiVEN.     On  Protein  Requirement,  Skandin.  Arch.  f.  Physiol.,  10,  91 ; 

11,  308. 
VON  NooRDEN.    MctaboHsm  and  Practical  Medicine,  vol.  i,  pp.  283,  383. 


CHAPTER   VIII 

THE    SIGNIFICANCE    OF    LIPOIDS    AND    VITAMINES    IN 
ANIMAL    METABOLISM 

In  Collaboration  with 

A.  Bruce  Macallum,  A.B.,  M.D. 

Lipoids:  Nitrogenous  Importance  of  Lipoids;  Lipoids  in  Metabolism; 
Bio-electric  Potentiality  of  Lipoids. 

Vitamines:  Nature  of  Vitamines;  Isolation  of  Vitamines;  Physiological 
and  Pharmacological  Properties  of  Vitamines;  Destructive  Action  of 
Heat  on  Vitamines;  Antineuritic  Vitamines;  Vitamines  in  a  Well- 
balanced  Dietary;  Role  of  Vitamines  in  Metabolism;  Vitamine  Con- 
tent of  Foods;  Foodstuffs  Containing  Vitamines  and  Their  Anti- 
neuritic and  Antiscorbutic  Qualities;  Relation  of  Phosphorus  Content 
to  Vitamine  Content  of  Foodstuffs;  Vitamines  and  Pellagra. 

LIPOIDS 

Nitrogenous  Importance  of  Lipoids — Proteins  and  lipoids  form  the  prin- 
cipal component  parts  of  all  living  cells.  Liv'ing  protoplasm  is  a  mixture 
of  substances  and  solutions,  of  a  non-homogeneous  nature,  slightly  miscible 
^vith  each  other.  Consequently  there  is  a  substratum  of  colloidal  ma- 
terial, together  with  simpler  substances  of  a  water  soluble  nature  with  an 
affinity  for  the  colloidal  material.  It  is  the  oxidation  of  these  substances  in 
aqueous  solutions,  rather  than  the  colloidal  material  itself,  which  liberates 
the  energy  manifested  in  the  organism,  but  the  colloidal  material  makes 
the  conditions  and  supplies  the  enzymes  which  control  the  energy-yielding 
oxidations  and  other  metabolic  processes.  The  colloidal  materials  are  pro- 
duced by  polymerization  from  substances — fats,  amino-acids  and  salts  in 
solution  supplied  to  the  cells,  but  the  lipoids  are  a  sine  qua  non  to  enable 
most  of  these  substances  to  enter  the  cells.  Besides,  the  lipoids  are  of  such 
importance  in  the  process  of  nutrition,  and  together  with  protein  exert 
such  a  prominent  role  in  all  life's  processes,  that  we  deem  them  of  suf- 
ficient consequence  to  call  attention  to  their  essential  activities  in  the  sev- 

219 


220       SIGNIFICANCE    OF    LIPOIDS    AND    VITAMINES 

eral  phases  in  metabolism.  They  are  absolutely  indispensable  to  man  and 
a  constant  supply  is  essential  to  the  organism. 

The  lipoids(l)  are  a  group  of  organic  nitrogenous  substances  com- 
prising the  phosphatids,  cerebrosids  and  cholesterin.  The  phosphatids 
contain  phosphorus,  an  organic  base,  and  a  fatty  acid  radicle  in  their 
molecule.  The  members  of  this  series  are  lecithin,  cephalin  and  cuorin. 
They  are  widely  distributed  in  both  animal  and  vegetable  cells,  but  are 
especially  abundant  in  the  yolk  of  eggs,  fish  roe,  brain  tissue,  yeast,  blood 
and  bile.  They  are  also  found  to  a  lesser  extent  in  cereal  grains,  legumes 
and  beet  root.  The  cerebrosids  are  isolated  almost  entirely  from  brain  and 
nerve  tissue.  These  do  not  contain  phosphorus  and  yield  galactose  upon 
hydrolysis  with  dilute  mineral  acids.  Cholesterin  is  an  unsaturated  sec- 
ondary alcohol,  is  universally  present  in  animal  and  vegetable  tissue, 
and  is  most  abundant  in  bile,  yolk  of  eggs,  nerve  tissue  and  wool  fat,  and 
found  abundantly  in  wheat,  barley,  beans,  peas,  lentils,  cariots,  peanuts 
and  beets. 

Lipoids  in  Metabolism. — The  importance  of  the  lipoids  in  mammalian 
nutrition  is  illustrated  by  the  fact  that  the  growth  of  the  brain  is  directly 
proportionate  to  the  lecithin  content  of  the  mother's  milk.  A  number  of 
investigators  have  asserted  that  the  lipoids  are  essential  for  the  main- 
tenance of  life  and  growth,  but  when  lipoids  in  a  comparatively  pure 
state  are  added  to  lipoid  free  diets,  no  beneficial  results  follow.  In  these 
cases  where  the  lipoids  were  extracted  from  the  food  before  feeding  it  to 
animals,  the  vitamine  fraction  was  removed  along  with  the  lipoids  and  for 
this  reason  the  purified  lipoids  gave  mj  relief  to  the  symptoms  resulting 
from  the  use  of  the  lipoid  free  diet.  Cholesterol  is  also  an  essential  factor 
in  metabolism,  as  Landers' (2)  experiments  prove  that  it  cannot  be  syn- 
thetized  by  the  mammalian  animal  tissue  and  it  is  promptly  incorporated 
from  the  diet  and  tenaciously  retained  by  the  body  when  animals  are  on 
a  lipoid  free  diet.  He  demonstrated  anew  that  pure  cholesterol  added  to 
a  lipoid  free  ration  resulted  neither  in  increment  of  growth  of  the  young 
nor  maintenance  of  life.  Fowls  on  the  other  hand  can  synthetize  lipoids 
or  tjieir  mother  substances  from  a  lipoid  free  diet(3).  The  lipoid  group 
in  the  normal  diet,  apart  from  its  function  as  a  source  of  absorbed  vita- 
mines,  is  of  importance  in  replacing  the  lipoid  deficiency  following  the 
lipoid  catabolism. 

Lipoids  are  easily  permeable  by  substances  soluble  in  fat,  but  it  is  with 
the  greatest  difficulty  that  they  are  permeated  by  solutions  of  salt,  sugar 
and  similar  substances.  The  amino-acids  are  lipoid  solvents (4)  and  their 
method  of  entering  the  cells  is  through  the  lipoid  spaces  in  the  outer  layer 


VITAMINES  221 

of  the  plasma  membrane  of  the  cells.  Meyer  is  the  authority  for  the  state- 
ment that  these  peculiar  lipoids  which  intersect  and  surround  the  living 
protoplasm  with  walls  of  froth,  so  to  speak,  are  of  decisive  importance  in 
the  life  and  functions  of  the  cells.  It  is  claimed  that  their  presence  pre- 
vents a  fusion  of  the  innumerable  particles  of  the  cell,  and  at  the  same 
time  they  protect  it  against  a  too  rapid  ingress  and  egress  of  water,  as  well 
as  against  invasion  by  salts  and  other  substances  dissolved  in  the  blood 
and  organic  fluids.  Besides  this,  they  possess  another  function  of  acting 
as  a  sort  of  sieve  for  all  the  substances  soluble  in  fat,  and  for  those  which 
dissolve  in  them  more  readily  than  water. 

Bio-electric  Potentiality  of  Lipoids. — According  to  Loeb  and  Beutner(5) 
the  lipoids  confer  on  the  cells  the  property  of  bio-electrical  potentiality. 
Lillie((})  has  shown  that  the  cells  owe  the  property  of  irritability,  or  the 
power  of  responding  to  the  various  stimuli,  to  the  lipoids.  Therefore, 
the  great  importance  of  the  lipoids  in  the  organic  processes  of  the  dells 
becomes  apparent  to  the  student  of  tropho-dynamics.  Moreover,  it  is  in 
accord  with  Schauman's  phosphorus-deficiency  theory  of  beriberi,  pel- 
lagra and  other  deficiency  diseases. 

VITAMINES 

Nature  of  Vitamines — Vitamines  is  a  term  first  applied  by  P'unk(Y) 
to  certain  substances  of  undetermined  structure  which  occurred  in  the 
outer  parts — pericarp — o£  cereals,  and  we  are  especially  indebted  to  him 
for  pioneer  work  in  this  particular  field.  Cooper(8)  holds  that  vita- 
mines are  neither  proteins,  fats  nor  lipoids,  and  there  is  no  evidence  that 
they  are  carbohydrates ;  so  they  cannot  yet  be  classed  with  either  protein, 
carbohydrate,  fats  or  salts,  tliough  the  teaching  at  the  present  time  seems 
to  suggest  that  they  may  enter  into  the  molecule  of  certain  lipoids.  This 
belief  is  emphasized  by  Carl  Voegtlin(O),  who  has  done  considerable  ex- 
perimental research  on  the  subject.  Some  investigators  are  inclined  to  the 
opinion  that  there  are  different  vitamines  which  are  active  in  preventing 
disease — one  for  beriberi,  one  for  scurvy,  one  for  pellagra,  etc.  Vita- 
mines are  present  in  foodstuffs  in  such  exceedingly  small  amounts  that 
they  cannot,  it  seems,  have  any  caloric  value,  and  yet  they  are  positively 
essential  to  health,  growth  and  development. 

Isolation  of  Vitamines. — We  are  indebted  to  Funk  (10)  for  first  devis- 
ing a  method  of  obtaining  the  antineuritic  vitamine  in  a  more  or  less  pure 
form  of  very  powerful  physiological  activity.  He  was  able  to  isolate  a  crys- 
talline substance,  a  few  milligrams  of  which  administered  to  a  polyneuritic 
pigeon  (experimental  beriberi)  led  to  a  complete  recovery  of  the  paralytic 


222       SIGNIFICAIs^CE    OF    LIPOIDS    AND    VITAMINES 

symptoms  in  a  very  few  hours.  According  to  Fimk,  this  crystalline  sub- 
stance seems  to  have  a  melting  point  of  233°  C,  and,  on  analysis,  contains 
carbon,  nitrogen,  hydrogen  and  oxygen.  It  is  regrettable,  though,  owing 
to  defective  methods,  that  the  yield  in  this  active  substance  is  very  poor, 
only  a  very  minute  quantity  being  obtained  from  hundreds  of  pounds  of 
natural  foods,  rich  in  these  accessory  bodies. 

At  the  present  time  the  antiscorbutic  vitamine  has  not  been  isolated, 
and  about  all  that  is  known  to-day  is  that  it  is  fairly  stable  in  acid  media 
which  probably  accounts  for  the  popularity  of  lemon  juice  as  an  antiscor- 
butic. For  the  same  reason  milk,  having  an  amphoteric  reaction,  on  being 
heated  for  a  considerable  time  to  a  temperature  exceeding  212°  F.,  loses 
its  antiscorbutic  properties,  and  when  forming  the  exclusive  diet  for  chil- 
dren may  give  rise  to  the  appearance  of  infantile  scurvy. 

Physiological  and  Pharmacological  Properties  of  Vitamines. — The  physio- 
logical and  pharmacological  properties  of  the  vitamines  have  not  been 
studied  extensively.  The  principal  points  which  have  been  established  are 
that  they  do  not  possess  toxic  properties,  and  that  even  in  remarkably  in- 
finitesmal  amounts,  they  relieve  the  symptoms  of  deficiency  disease  in 
both  man  and  animals. 

Funk (11),  Braddon  and  Cooper (12)  have  recently  pointed  out  the 
interesting  relation  between  carbohydrates  and  the  antineuritic  substances. 
They  found  that  in  order  to  prevent  the  occurrence  of  polyneuritis  (ex- 
perimental beriberi)  in  pigeons,  it  was  necessary  to  administer  to  the  bird 
an  infinitesnial  quantity  of  antineuritic  substance  for  each  gram  of  car- 
bohydrate in  the  diet  of  the  pigeon.  It  was  further  foimd  that  when  the 
carbohydrate  component  of  the  pigeon's  diet  was  increased,  the  vitamine 
content  also  had  to  be  increased  accordingly.  These  discoveries  emphasize 
the  earlier  observations,  that  a  diet  rich  in  cabohydrate  is  more  apt  to  give 
rise  to  the  appearance  of  the  symptoms  of  beriberi  than  a  diet  poor  in  car- 
bohydrate. 

The  table  on  page  226,  from  Voegtlin(13),  graphically  illustrates  the 
relative  vitamine  content  of  foods,  showing  in  the  order  arranged  the  foods 
that  are  richest  in  both  the  antineuritic  and  antiscorbutic  vitamines.  It  is 
not  intended  that  this  table  be  taken  as  absolutely  accurate,  but,  at  the 
present  time  it  is  as  accurate  as  the  present  state  of  our  knowledge  will 
permit,  and  may  be  of  value  in  helping  to  elucidate  the  question  of  the 
proper  selection  of  foods  to  constitute  a  satisfactory  dietary  for  the  de- 
ficiency diseases. 

Destructive  Action  of  Heat  on  Vitamines. — From  the  conclusions  of 
research  workers  in  this  particular  field  of  biology,  we  may  assume  that 


VITAMINES  223 

the  antiiieiiritic  vitaniine  is  j)resent  in  foods  in  a  combined  form,  whicli  is 
much  more  resistant  than  the  free  curative  substance.  This  is  of  momen- 
tous importance  as,  in  the  process  of  cooking,  tlie  food  is  subjected  to  a 
temperature  of  212"  F.,  but  beyond  this  degree  up  to  266*^  F.  for  any  con- 
siderable length  of  time,  the  vitamines  are  completely  destroyed.  Vita- 
mines  are  fairly  susceptible  to  temperatures  above  100"  C.  (212"  F.). 

Various  experiments (14),  conducted  on  both  man  and  animals,  show 
that  the  prolonged  heating  of  foods  to  a  temperature  of  120°  C.  (270°  F.) 
for  one  to  three  hours  will  destroy  most  of  the  physiological  activity  of  the* 
vitamines  originally  present  in  the  foods.  Funk  has  recently  experimented 
with  canned  beef,  and  found  that  when  fed  to  a  dog  to  the  exclusion  of  all 
other  aliment,  the  animal  died  in  two  weeks'  time. 

Antineuritic  Vitamines — Funk,  who  has  done  more  work  on  this  sub- 
ject than  any  other  investigator,  succeeded  in  obtaining  a  small  quantity  of 
antineuritic  vitamine  from  dried  ox-brain;  later  Voegtlin  and  Towles 
succeeded  in  demonstrating  its  presence  in  crude  extracts  from  the  spinal 
cord.  It  would  appear  probable,  therefore,  that  the  antineuritic  substance 
forms  an  essential  part  of  the  nerve  cell  and  fiber,  and  that  its  presence  in 
nerve  tissue  in  sufficient  amoimt  is  essential  for  proper  function  of  the 
spinal  cord.  Degeneration  of  the  nerve  tissues  will  take  place  whenever 
the  vitamine  content  of  the  nerve  tissues  is  depleted  through  a  dietary 
deficient  in  vitamine.  Voegtlin  (15)  has  emphasized  the  fact  that  lipoids 
and  antineuritic  vitamine  are  proportionately  distributed  throughout  the 
body,  possibly  due  to  the  lipoid  solubility  of  the  antineuritic  vitamine. 
The  animal  body  seems  to  have  a  peculiar  tenacity  for  holding  on  to  its 
vitamine  supply,  for  the  latter  author  quoted  says : 

If  we  change  the  diet  of  man  from  one  sufficient  in  vitamine  to  one  deficient  in 
vitamine,  we  find  as  a  rule,  it  takes  several  weeks  or  even  months  before  obvious 
and  well-defined  sjonptoms  of  deficiency  diseases  appear.  One  might  ask  why  the 
body  does  not  react  more  rapidly  to  a  deficient  diet.  Apparently  the  initial  vita- 
mine content  of  the  body,  which  in  absolute  terms  probably  amounts  to  only  a  few 
g^ams  in  a  person  weighing  100  pounds,  is  not  easily  used  up  or  eliminated  together 
with  their  excretions.  The  catabolism  of  vitamine,  if  there  is  such  a  thing,  must 
be  extremely  slow.  If  vitamines  do  occur  in  the  colloidal  state,  and  a  number  of 
facts  seem  to  prove  this  assumption,  it  is  very  likely  that  certain  other  body  colloids 
may  fix  vitamines  in  the  tissue  fluids  by  means  of  absorption. 

Traube(lO)  has  attempted  to  show  that  certain  alkaloids  with  very 
powerful  and  prolonged  physiological  action  occur  in  the  form  of  colloids. 

The  fact  that  these  substances  are  colloidal  may  be  one  of  the  reasons  for  their 
powerful  physiological  activity,  especially  as  the  recent  teachings  of  bio-chemistry 


224      SIGNIFICANCE    OF    LIPOIDS    AND    VITAMINES 

seem  to  supjiort  the  view  tliat  life  itself  is  largely  dependent  on  the  colloidal  state 
of  living  matter. 

Vitamines  in  the  Well-balanced  Dietary. — Ever  since  Stepp(l7)  dem- 
onstrated that  the  growth-promoting  element  in  the  diet  could  be  removed 
by  extraction  with  alcohol,  the  lipoids,  which  constituted  the  bulk  of  the 
extract,  were  supposed  to  be  the  factors  which  enabled  the  animal  body 
to  attain  adult  size  and  weight.  The  subsequent  researches  of  Funk  on 
the  etiology  of  beriberi  revolutionized  some  of  the  current  conceptions 
of  nutrition  and  indicated  a  new  avenue  of  approach  towards  the  solu- 
tion of  animal  growth.  The  plan,  which  proved  so  successful  in  the 
antineuritic  investigation,  was  applied  to  the  elucidation  of  the  growth 
problem (18).  The  experimental  evidence  accumulated  since  then  is  now 
sufficient  to  substantiate  the  vitamine  theory  in  regard  to  this  important 
phase  of  animal  physiology. 

Stepp  also  has  advanced  the  opinion  that  vitamines  and  lipoids  are 
the  two  essential  factors  in  nutrition  during  the  growth  period(19). 
The  physiological  activity  of  these  growth-inducing  fractions  from  yeast 
and  pancreas  depreciates  with  each  successive  step  in  the  preparation 
of  the  active  :fraction,  as  in  the  case  of  antineuritic  vitamine;  and  con- 
siderably larger  quantities  are  necessary  to  enable  the  animal  to  attain 
its  customary  growth  increment  than  are  required  to  effect  a  cure  in 
the  case  of  polyneuritic  pigeons.  These  growth  "vitamines"  or  "acces- 
sories" do  not  in  themselves  directly  stimulate  the  growth  of  the  animal 
cell.  Their  action  in  this  respect  consists  in  each  and  every  specific 
vitamine  being  present  in  a  diet  otherwise  adequate,  and  playing  their 
part  in  maintaining  the  metabolic  equilibrium.  In  this  way  the  main- 
tenance of  the  normal  physico-chemical  conditions  is  established,  since 
the  nucleus  and  protoplasm  of  the  animal  cell  possesses  the  inherent 
capacity  to  grow  and  reproduce  when  adequately  nourished.  It  is  yet  to  be 
proved  that  there  is  any  factor  in  the  diet  which  alone  can  bring  about 
growth  of  any  animal  cell  for  lengthy  periods,  in  the  strict  sense  of  the 
term  "specific  growth  substance." 

Careful  experimental  research  has  emphasized  the  fact  that  each  indi- 
vidual needs  a  different  amount  of  food,  which  will  vary  according  to  his 
structure  and  surroundings;  he  will  need  certain  types  of  protein,  carbo- 
hydrates, fat  and  salts,  in  addition  to  water,  and  finally  he  must  have 
other  substances,  generically  called  vitamines,  if  he  is  to  show  physical 
growth. 

Role  of  Vitamines  in  Metabolism. — The  study  of  dietetics  from  the 
point  of  view  of  the  vitamines  has  only  just  begun,  and  the  exact  role  they 


VITAMINES  225 

play  in  metabolism  has  not  yet  been  elucidated,  but  it  has  been  clearly 
demonstrated  that  certain  deficiency  diseases  are  due  to  the  lack  of  certain 
accessory  foods.  Pellagra,  beriberi,  scurvy  and  other  deficiency  diseases 
are  to  be  controlled  or  prevented  through  the  administration  of  the  proper 
foods  containing  the  adequate  vitamines(20).  A  number  of  foods  and 
dietary  rules  for  use  in  order  to  prevent  these  deficiency  diseases  have 
been  outlined  in  these  pages  (21).  In  any  institution  where  bread  is  the 
staple  article  of  diet,  it  should  be  made  from  whole-wheat  flour.  Rice 
used  in  any  quantity  should  be  of  the  brown  undermilled  variety.  Beans, 
peas  or  other  legumes  known  to  prevent  beriberi,  should  be  served  at  least 
once  a  week.  Canned  beans  or  peas  should  not  be  used.  Some  fresh  vegeta- 
ble or  fruit  should  be  issued  at  least  twice  a  week,  and  barley,  a  known  pre- 
ventive of  beriberi,  should  be  used  in  all  soups.  Corn  meal  should  be  of 
water-ground  variety,  i.  e.,  made  from  the  whole  grain.  White  potatoes 
and  fresh  meat  should  be  served  at  least  once  a  week,  preferably  once  daily, 
as  they  prevent  scurvy  and  beriberi.  The  undue  use  of  canned  goods 
must  be  carefully  avoided  (22). 

Fortunately,  in  this  country,  the  majority  of  the  inhabitants  live  on  a 
fairly  well  mixed  dietary,  and  thereby  escape  outbreaks  of  beriberi  and 
scurvy.  According  to  the  opinion  of  Dr.  Carl  Voegtlin(23),  of  the  United 
States  Public  Health  Service,  who  has  conducted  extensive  research  along 
this  line  of  experimentation,  it  seems  fairly  well  established  that  the  sub- 
stances preventing  beriberi  are  present  in  the  natural  foods  largely  in  a 
combined  form,  which  is  soluble  in  90  per  cent  alcohol  or  water,  and  when 
present  in  sufficient  quantity  in  the  alimentation  will  prevent  the  occur- 
rence of  beriberi. 

This  mother  substance  can  be  split  off  by  acid  hydrolysis  or  autolysis,  by  means 
of  enzymes  yielding  after  fractionation  a  substance  with  very  powerful  curative 
property,  which  if  given  patients  suffering  from  beriberi,  will  relieve  the  distress- 
ing sjmaptoms  in  a  very  few  days. 

At  the  present  time  very  little  is  known  of  the  chemical  nature  of  the 
mother  substance  of  this  beriberi  vitamine.  It  is  interesting  to  note  that 
the  latest  researches  seem  to  point  to  the  fact  that  foods  rich  in  lipoids  are 
also  rich  in  vitamines,  and  the  observations  of  Sullivan  and  Voegtlin(24) 
call  attention  to  the  fact  that  "the  solubility  of  the  mother  substance 
of  the  antineuritic  substance  in  alcohol,  might  lead  to  the  belief  that  vita- 
mines  enter  into  the  molecule  of  certain  lipoids."  They  also  hold  that  the 
antineuritic  vitamine  is  probably  not  in  combination  with  carbohydrates, 
since  the  starchy  part  of  all  cereal  foods  seems  to  be  very  poor  in  this  sub- 


226      SIGNIFICANCE    OF    LIPOIDS    AND    VITAMINES 

stance.  Some  competent  observers  hold  to  the  view  that  certain  parts  of 
the  protein  molecule,  more  especially  the  nucleic  acids,  may  possibly  bold 
in  combination  the  active  "accessory  substances,"  but  this  is  still  an  un- 
settled question.  The  fact  that  foods  rich  in  nucleated  cells  are  also  rich 
in  antineuritic  substance,  might,  perhaps,  be  accepted  as  evidence  of  the 
truth  of  this  assumption. 

Vitamine  Content  of  Foods. — Vitamines  are  contained  in  varying  pro- 
portions in  all  food  products,  some  food  constituents  being  rich  in  them 
and  others  very  poor.  Again,  in  other  foods,  the  vitamine  is  abstracted 
or  destroyed  in  the  various  processes  of  preparation  and  cooking.  An 
ordinary  mixed  diet  contains  enough  vitamine  to  sustain  nutrition.  Un- 
less the  food  contains  sufficient  vitamine  principles,  no  matter  how  large 
quantities  are  consumed,  there  will  be  malnutrition.  This  is  the  ease 
among  the  poor,  who  consume  large  quantities  of  food  which  is  neither 
proportionately  balanced  nor  sufficiently  varied  to  furnish  the  requisite 
vitamine  content.    For  this  reason  diseases  of  malnutrition  are  common. 

The  animal  body  is  unable  to  produce  the  known  vitamines  from  vita- 
mine-free  food.  All  the  higher  animals,  including  man,  according  to 
Voegtlin(25),  get  their  vitamine  supply  directly  or  indirectly  from  the 
vegetable  kingdom.  Plant  life  synthetizes  the  vitamine,  and  man  obtains 
the  required  vitamine  supply  by  partaking  either  of  animal  or  vegetable 
food.  The  cow  stores  up  vitamine  in  her  body  from  grasses,  grains  and 
fodder,  which  she  consumes.    A  portion  of  it  is  excreted  in  her  milk,  sup- 

RELATIVE  VITAMINE  CONTENT  OF  FOODS 


Antineuritic  Properties 

Antiscorbutic  Properties 

Relatively  Rich 

Relatively  Poor 

Relatively  Rich 

Relatively  Poor 

Brewer's  yeast 

Egg  yolk 

Ox  heart 

Milk 

Beef  and  other  fresh 

meat 
Fish 
Beans 
Peas 
Oats 
Barley 
Wheat 
Corn  and  other  cereals 

Sterilized  milk 
Sterilized  meat 
Cabbage 
Turnips 

Carrots  and  other  veg- 
etables of  this  type 
Highly  milled  cereals 
Starch 
Pork 
Molasses 
Corn  Syrup 

Fresh  vegetables 
Fresh  fruits 
Raw  milk 
Raw  meat 
Cereals  sprouting 

Dried  vegetables 
Dried  fruits 
Sterilized  milk 
Canned  meat 
Dried  cereals 
Pork  fat 
Starch 
Molasses 
Corn  Sirup 

VITAMINES  227 

plying  the  calf  with  necessary  vitamine,  and  at  the  same  time  furnishing 
a  valuable  source  of  vitamine  for  man.  The  hen  derives  vitamine  from 
the  cereals  she  eats,  and  transfers  a  part  of  it  to  the  eggs  she  lays.  The 
vegetable  kingdom,  therefore,  furnishes  the  vitamine  supply  so  essential 
to  animal  life,  and  the  plant  laboratory  builds  up  vitamine  from  simple 
inorganic  compounds. 

A  careful  study  of  the  table  on  page  226  shows  that  a  mixed  diet  can  be 
outlined  which  will  include  sufficient  animal  foods,  such  as  fresh  milk, 
eggs,  meat  and  a  variety  of  fresh  vegetables  containing  sufficient  anti- 
neuritic  and  antiscorbutic  substances  to  make  a  satisfactory  well-balanced 
mixed  dietary.  Ordinarily  the  dietary  habits  of  the  major  portions  of  the 
population  of  this  country  are  such  that  sufficient  fresh  animal  and 
vegetable  foods  are  consumed  to  overcome  any  deficiency  of  vitamines  in 
the  diet. 

Prior  to  1878  wheat  and  corn  were  ground  on  the  old-fashioned  buhr 
millstones  ("water-ground")  to  the  desired  degree  of  fineness.  The  result- 
ing wheat  flour  or  cornmeal,  from  which  the  coarser  particles  of  bran  .were 
partially  sifted  out,  was  then  used  for  making  bread.  Such  bread  con- 
tained 1.75  per  cent  cereal  salts,  all  that  was  in  the  grain  when  it  left  the 
harvest  field,  while  the  new  patent  roller-process  flour  of  to-day  contains 
0.44  per  cent  mineral  matter.  During  the  past  five  or  six  decades  the  mill- 
ing industry  has  completely  revolutionized  the  grinding  of  grains.  By 
means  of  the  patent  roller-process  it  has  been  made  possible  to  separate 
the  various  parts  of  the  grain,  the  germ  and  the  bran,  from  the  endosperm, 
or  starchy  part,  which  could  then  be  ground  to  the  desired  fineness,  and 
which,  on  account  of  its  whiteness,  appealed  to  the  public  as  an  assum- 
ably  purer  product.  It  is  admitted  that  the  "highly  milled"  wheat  flour 
and  corn  meal  obtained  by  the  patent  roller-process  are  superior,  so  far 
as  looks  and  keeping  qualities  are  (Concerned,  to  the  old-fashioned  water- 
ground  products ;  but  at  the  same  time,  imfortunately,  this  modern  method 
of  milling  deprives  the  finished  products  of  some  of  the  most  valuable 
food  constituents  of  the  grains.  The  Bureau  of  Chemistry  of  the  Depart- 
ment of  Agriculture  and  the  Hygienic  Laboratory  have  made  a  large  num- 
ber* of  analyses  of  highly  milled  wheat  flour  and  corn  meal,  which  clearly 
show  that  the  highly  milled  wheat  flour  and  corn  meal  contain  less  protein, 
leas  fat  and  less  cereal  salts  than  the  old-fashioned  water-ground  product.^ 

The  highly  milled  products  from  wheat,  corn  and  rice  are  deficient  in 
the  essential  accessory  food  substances,  vitamines,  which,  as  previously 


1  .Sffe  Corn,  Corn  Products  and  (Grinding,  Volume  I,  Chapter  XIII,  pages  392-396. 


228       SIGNIFICANCE    OF    LIPOIDS    AND    VITAMINES 

pointed  out,  are  contained  in  the  intact  kernel  in  the  outer  pericarp,  or 
aleurone  layer,  and  probably  also  in  the  genu  or  embryo.  As  pointed  out, 
the  modern  roller  process  eliminates,  to  a  great  extent,  the  bran  and  germ, 
and  as  a  result  the  highly  milled  product,  as  might  be  expected,  is  de- 
ficient in  vitamines,  which  assumption  has  been  amply  proven  by  recent 
investigations  conducted  by  Funk  and  his  coworkers,  and  later  by  Myer 
and  Voegtlin  of  the  Public  Health  Service(26). 

Foods  Containing  Vitamines  and  Their  Antineuritic  and  Antiscorbutic 
Qualities. — Laboratory  experimentation  (27)  has  proved  that  butter-fat 
promotes  the  normal  growth  of  young  rats,  while,  under  the  same  dietary 
conditions,  lard  and  some  other  fats  fail  to  do  this  (28).  Therefore,  the 
question  has  arisen,  ''What  is  the  special  constituent  of  the  butter  fat 
which  aids  normal  growth  and  development?"  Osborne  and  ]\rendel(2i)) 
question  the  presence  of  nitrogen  and  phosphorus  in  tlie  butter-fat  used 
in  their  feeding  experiments,  McCollum  and  Davis  (80)  question  the  ab- 
sence of  nitrogen  and  phosj^jhorus  ■  from  this  fat,  and  Otto  Folin  agrees 
with  the  latter,  stating  that  there  was  extracted  a  trace  of  nitrogen  equal 
to  0.2  mg.  from  10  grams  of  butter-fat.  Funk  and  Macallum(31)  suc- 
ceeded in  obtaining  nitrogen  from  centrifuged  butter-fat,  in  small  amount, 
equal  to  31  mg.  nitrogen  (16.8  —  14.0  mg.)  from  12  kilograms  of  butter- 
fat.  Gies,  of  New  York,  reports  that  from  21.3  grams  of  butter-fat  he  was 
able  to  isolate  phosphorus  in  infinitesmal  amount.  From  the  researches 
of  Funk,  Osborne,  Mendel,  Davis,  Macallum  and  their  followers,  butter- 
fat  undoubtedly  contains  a  growth  promoting  substance  which  may  be  an 
accessory  food  substance  or  vitamine.  It  is  a  well-known  fact  that  butter 
contains  about  15  per  cent  of  buttermilk  (see  analysis.  Volume  I,  Chapter 
XII,  page  336),  which  is  rich  in  both  phosphorus  and  nitrogen.  This 
growth-promoting  substance  in  butter-fat  belongs,  in  all  probability,  to 
the  same  class  of  so-called  "accessory  dietary  constituents."  We  do  not 
know  at  the  present  time  whether  or  not  this  substance  is  identical  with 
some  vitamines,  but  the  presumption  is  that  this  is  the  case.  Later  re- 
searches demonstrate,  however,  that  butter-fat  possesses  no  antineuritic 
vitamine,  and  that  its  action  is  in  part  antiscorbutic,  in  addition  to  a  sec- 
ond factor  as  yet  indefinable  (32). 

Rice  has  long  been  regarded  as  an  etiological  factor  in  the  causation  of 
beriberi,  and  modern  research  and  clinical  experimentation  has  at  last  sat- 
isfactorily settled  the  question  affirmatively.  As  previously  stated  (Vol- 
ume I,  Chapter  XIII,  page  391),  the  rice  grain  contains  an  outer  cover- 
ing or  chaff,  beneath  which  is  a  husk  or  pericarp  surrovinding  the  subperi- 
carpial  or  aleurone  layer,  which  in  turn  encloses  the  main  central  part  of 


VITAMINES  229 

tlie  grain  or  enclosperin,  eoiisi8tiiig  cliietly  of  starchy  matter.  Tlie  vita- 
iiiiues  are  preseut  iu  the  suhpericarpial  or  aleurone  layer.  The  vitaiuine 
is  a  nitrogenous  substance,  but  lacking  in  phosphorus.  It  is  soluble  in 
water,  alcohol  and  dilute  acids.  It  is  undoubtedly  destroyed  by  heat  above 
212°  F.  Machine  polished  rice  consists  solely  of  starchy  endosperm, 
the  pericarp,  suhpericarpial  or  aleurone  layer  being  completely  removed  in 
the  polishing  processes.  This  rice  is  the  ordinary  commercial  white  rice, 
and  is  devoid  of  vitamine,  and  birds  fed  on  such  rice  will  rapidly  develop 
polyneuritis,  which  will  prove  fatal.  Human  beings  subsisting  on  a  die- 
tary composed  largely  of  polished  rice  will  develop  beriberi,  unless  the 
other  adjuvants  of  the  diet  supply  the  requisite  amount  of  vitamine.  Rice 
from  which  the  husk  or  chaff  is  removed  by  steaming  or  treatment  with 
hot  water  (parboiled  rice),  subsequently  rubbed  in  a  mortar  by  hand  and 
afterwards  prepared  for  human  consumption,  will  not  produce  beriberi, 
for  the  reason  that  during  the  crude  method  of  milling,  a  large  percentage 
of  the  suhpericarpial  or  aleurone  layer,  which  contains  the  vitamine  sub- 
stance so  essential  to  the  dietary,  is  left  adherent  to  the  grain. 
According  to  Wilcox  (33)  : 

In  animals  in  whom  polyneuritis  or  beriberi  has  been  caused  by  feeding  on  pol- 
ished rice,  the  symptoms  quickly  clear  up  if  the  native  unhusked  rice — i.  e.,  the  rice 
from  which  the  husk  has  not  been  removed  by  previous  treatment  with  steam  or 
hot  water — is  substituted  for  the  polished  rice.  Instead  of  this,  the  addition  to  the 
polished  rice  of  an  extract  of  the  rice  polishings  will  have  the  same  beneficial  effect, 
the  katjang  idjoe  bean  also  contains  anti-beriberi  vitamine  and  its  addition  in 
amount  of  ?.  lb.  a  day  to  a  polished  rice  diet  will  prevent  beriberi  in  natives. 

r.  Gowland  Hopkins (34),  in  his  recent  researches  to  determine  the 
important  ])art  played  by  vitamines  in  metabolism,  has  confirmed  the  con- 
clusions of  Funk(35),  Fraser,  Stanton,  Eykman  and  Cooper  of  definitely 
establishing  the  important  fact  that  beriberi  is  essentially  a  deficiency  dis- 
ease. Modern  clinical  research  on  metabolism  has  conclusively  proved 
that  a  diet  of  pure  protein,  fat  and  carbohydrate,  with  a  due  allowance  of 
proper  admixtures  of  salts  and  water,  is  not  sufficient  to  maintain  health, 
though  the  quantity  allowed  may  be  theoretically  correct.  A  growing 
animal  fed  on  the  above  ternary  food  principles  with  proper  mineraliza- 
tion will  cease  to  grow  and  will  develop  some  deficiency  disease,  such  as 
beriberi,  scurvy,  etc.  Some  other  addition  to  the  dietary  is  vitally  neces- 
sary, if  the  animal  is  to  maintain  health  and  thrive.  Many  natural  foods 
contain  these  essential  substances  which  need  only  be  present  in  the  most 
minute  amount,  in  order  to  make  the  diet  amply  sufficient  for  growth  and 
honltli.  Yeast,  for  instance,  is  a  substance  which  is  perhaps  richest  in 
115 


230      SIG^nFICANCE    OF    LIPOIDS    AN^D    VITAMIXES 

vitaiiiiiie.  The  yolk  of  eggs,  brain,  liver^  kidneys,  sweetbread,  oatmeal^ 
haricot,  beans,  peas,  etc.,  are  all  fairly  rich  in  this  vitamine  substance, 
while  milk  and  fresJi  meat  contain  vitamines  in  smaller  amounts.  The 
subpericarpial  or  aleurone  layer  of  rice  is  richer  in  organic  phosphorus 
than  the  endosperm,  and,  as  a  result,  it  has  been  found  that  rice  poor  in 
phosphorus  is  more  likely  to  cause  beriberi  (polyneuritis  of  fowls)  than 
whole  rice. 

A  dietary  deficient  in  these  accessory  substances  gives  rise  to  beriberi, 
which  is  a  disease  of  the  peripheral  nervous  system,  prevalent  in  eastern 
countries,  Japan  and  the  Philij)pines,  wliere  the  inhabitants  subsist  almost 
entirely  upon  a  diet  composed  largely  of  highly  milled  "polished  rice." 
It  is  believed  that  even  in  our  own  country  an  alimentation  composed 
almost  entirely  of  foods  from  highly  milled  wheat- — "patent  roller-process 
flour,"  would  produce  beriberi  in  ninety  days;  in  fact,  Little(36)  reports 
an  outbreak  of  beriberi  among  the  fishermen  of  Newfoundland,  who  sub- 
sisted mainly  upon  alimentation  composed  largely  of  highly-milled  pat- 
ent roller-process  flour.  It  is  known  that  beriberi  does  not  develop  in 
persons  living  on  foods  made  from  whole-wheat  flour  or  from  whole  rice. 
In  other  words,  as  previously  pointed  out  (Volume  I,  Chapter  XIII,  page 
377),  the  outer  portions  of  both  the  wheat  and  rice  grain,  namely,  the 
subpericarpial  or  aleurone  layers,  contain  the  "accessory  substances"  or 
vitamines  which  are  so  essential  to  the  dietary — for  the  prevention  of 
disease  of  the  peripheral  nervous  system  (beriberi  and  pellagra).  Like- 
wise research  by  competent  observers  in  cases  of  scurvy  has  established 
the  fact  that  beriberi  is  not  due  to  a  deficiency  of  the  ternary  elements 
of  the  dietary  proteins,  fats  and  carbohydrates,  but  to  certain  accessory 
food  substances  highly  essential  to  life  lacking  in  the  alimentation. 
Consequently  beriberi,  pellagra  and  scurvy  are  referred  to  as  deficiency 
diseases.  (See  chapter  on  Deficiency  Diseases,  Volume  III,  Chapter 
XVII. 

The  consensus  of  opinion  of  research  workers  in  deficiency  diseases, 
Fraser  and  Stanton(37),  Strong  and  Crowell(38),  in  the  Philippines, 
Van  Leent(39),  Vorderman(40),  Takaki(41),  Fletcher(42),  Highet 
(43),  Heiser(44),  Theze(45),  Chamberlain (46),  Vedder(47)  and  others, 
since  the  appearance  of  Funk's  work  on  the  vitamines,  is  that  beriberi  is 
a  disease  caused  by  dietary  deficiency  resulting  from  faulty  metabolism, 
due  to  the  lack  of  the  vital  accessory  food  substances  to  which  Funk  gave 
the  name  "vitamines." 

Working  along  this  line  of  research,  Williams  (48)  and  Seidell  have 
found  that  a  similar  isomerism  existing  in  these  substances  also  exists  in 


VITAMINES  231 

the  vitamine  of  yeast,  and  is  primarily  responsible  for  the  instability  of 
these  compounds,  which  has  so  far  prevented  their  isolation.  Adenin  is 
the  pnrin  base  in  yeast,  which  has  this  property  of  isomerism.  With  re- 
gard to  the  antinenritic  vitamine,  Vedder  has  proposed  the  hypothesis  that 
this  chemical  substance  acts  as  a  building  stone  of  the  complex  structure 
of  the  nervous  tissue,  without  which  it  cannot  be  repaired. 

All  of  the  foregoing  investigators  have  succeeded  in  obtaining  from 
rice  polishings  a  chemical  substance  which  in  doses  of  a  few  milligrams^ 
was  capable  of  curing  fowls  suffering  with  polyneuritis  induced  by  a  diet 
of  overmilled  rice. 

When  a  deficiency  of  vitamine  exists,  the  nervous  tissue  becomes  first  exhausted, 
and  then  degenerated  until  finally  the  symptoms  of  polyneuritis  appear  in  fowls 
or  dry  beriberi  in  man.    This  theory  is  based  on  experimental  observations  in  man. 

Thus  Vedder  and  Clark  (49)  found  that  the  mitochondria  in  the  nerves 
of  fowls  showed  definite  changes  after  seven  days  on  a  diet  of  polished 
rice,  and  long  before  the  fowls  showed  any  clinical  symptoms  of  poly- 
neuritis, and  these  changes  were  progressive  the  longer  the  deficiency  lasted 
until  evident  degeneration  could  be  demonstrated.  Chromatolysis  and 
changes  in  the  tigroid  substance  of  the  cells  of  the  cord,  similar  to  that 
observed  in  pigeons  which  have  been  exhausted  by  long  flights,  may  also 
be  demonstrated  in  birds  which  have  developed  polyneuritis. 

The  antinenritic  vitamine  is  the  only  one  of  the  accessory  food  substances  con- 
cerning which  there  is  sufficient  evidence  to  even  theorize  concerning  its  action  in 
the  body,  and  more  work  will  be  needed  before  any  adequate  conception  of  the 
physiological  action  of  the  vitamines  will  be  known.  The  study  of  beriberi,  scurvy, 
and  other  deficiencies  has  given  a  working  basis  that  there  are  a  number  of  differ- 
ent accessory  food  substances  or  vitamines  and  that  each  deficiency  disease  is  caused 
by  the  absence  of  its  particular  vitamine. 

Vedder,  from  his  own  experiments  and  those  of  other  investigators, 
considers  that  we  must  assume  that  there  is  a  Vv'hole  group  of  these  vita- 
mines, but  that  further  investigations  will  be  necessary  to  determine  the 
relation  of  these  various  substances  to  each  other. 

To  a  limited  extent,  in  the  mountainous  sections,  water-ground  wheat 
flour  and  com  meal  are  still  produced  on  the  old-fashioned  buhr  millstones. 
This  water-ground  flour  and  meal  contains  practically  all  of  the  vitamines 
and  all  of  the  mineral  salts  of  the  whole  grain,  while  the  highly  milled 
products  are  decidedly  deficient  both  in  the  cereal  salts  and  in  these  highly 
essential  accessory  substances. 

Three  or  four  decades  ago  all  grain,  especially  in  the  South,  was 


232      SIGNIFICANCE    OF    LIPOIDS    AND    VITAMINES 

ground  at  the  neighborhood  mill  on  the  old-fashioned  buhr  millstones, 
and  the  power  was  furnished  bj  the  nearby  stream.  By  this  method  of 
milling,  now  almost  entirely  replaced  by  the  steam  or  electric  patent 
roller-process,  only  the  coarser  particles  of  the  bran  and  outer  skin  or 
husk  were  removed. 

Two  years  ago  the  author  ^  spent  a  vacation  of  two  mouths  in  his 
native  state,  North  Carolina,  and  took  occasion  to  investigate  the  incidence 
of  pellagra  in  counties  far  removed  from  railway  accommodations,  particu- 
larly in  western  North  Carolina,  eastern  Tennessee  and  Kentucky.  The 
inhabitants  of  these  sections  are  too  far  removed  from  railway  facilities 
to  purchase  roller-process  meal,  and  must  send  their  com  to  the  nearby 
neighborhood  mill,  where  it  is  ground  in  small  quantities  at  a  time,  suf- 
ficient for  immediate  needs,  and  the  whole  meal  is  eaten,  furnishing  the 
necessary  vitamine  substance.  The  families  living  in  the  lowland  section, 
convenient  to  railroads,  buy  their  supply  of  patent  roller-process  meal  at 
the  village  store.  This  is  devoid  of  the  accessory  vitamine  substance,  and 
unless  the  dietary  is  augmented  by  fruits,  vegetables,  milk  or  fresh  meat 
supplying  the  accessory  substance,  deficiency  disease  will  soon  follow. 

Wood  (50),  writing  on  pellagra,  has  observed  that  in  an  eastern  county 
of  North  Carolina,  remote  from  railroad  facilities,  broad  areas  with  thou- 
sands of  inhabitants  are  free  from  pellagra.  The  inhabitants  of  this 
locality  consume  as  a  food  large  quantities  of  corn  meal,  but  it  is  a  whole 
meal  water-ground  product. 

Many  experiments  have  been  conducted  ^(51)  to  determine  the  correct 
physiological  estimation  of  the  vitamine  content  of  foods,  and  from  the 
available  data  collected  it  is  safe  to  assume  that  a  perfect  analogy  exists 
between  the  Avell-known  relation  of  polished  rice  to  its  nutritive  value  and 
the  high  milling  of  wheat  and  corn  to  the  nutritive  value  of  wheat  flour 
and  corumeal.  It  is  an  accepted  fact,  proved  by  numerous  investigations, 
that  if  the  alimentation  of  a  people  is  principally  composed  of  highly  pol- 
ished rice,  and  otherwise  deficient  in  vitamines,  beriberi  will  develop,  but 
on  the  other  hand,  if  undermilled  rice  is  substituted  for  the  highly  milled 
product  the  disease  is  not  so  likely  to  develop. 

The  extreme  importance  of  a  method  for  determining  the  vitamine 
content  of  foods,  and  of  isolating  these  all  important  accessory  substances 
is  quite  apparent. 

According  to  Funk,  the  vitamine  theory  is  so  new  that  "little  progress 
has  been  made  thus  far  in  the  isolation  of  the  vitamine  principle  in  suffi- 


1  Dr.  Fitch.     2  At  the  Hygienic  Laboratory,  Washington,  D.  C. 


VITAMINES  233 

cient  quantities  to  be  of  value  therapeutically,  because  most  of  tJie  vita- 
mine  was  lost,  destroyed  or  rendered  inert  in  the  processes  of  isolation." 
Kecent  investigations  carried  out  in  the  Hygienic  Laboratory  (52)  on  the 
vitaniine  content  of  brewer's  yeast,  gives  hope  of  better  results.  In  the 
past,  the  great  difficulty  had  been  to  isolate  the  vitaniine  in  sufficiently 
concentrated  amounts  to  make  it  of  practical  use  therapeutically.  This 
problem  has  at  last  been  solved  by  the  use  of  Professor  John  Uri  Lloyd's 
prepared  hydrous  aluminum  silicate (53)  ;  which  has  a  very  high  selective 
absorptive  power.  It  was  found  that  0.05  gram  of  this  solid  vitaniine 
product  would  keep  in  health  a  300-gi-am  pigeon  fed  exclusively  on  pol- 
ished rice  or  would  cure  in  a  very  few  hours  pigeons  that  had  already 
manifested  symptoms  of  polyneuritis  on  a  polished  rice  diet.  Control 
pigeons  fed  on  polished  rice  and  untreated  with  vitamine  soon  died  with 
polyneuritis.  According  to  research  workers  in  the  Hygienic  Laboratory, 
it  would  seem  that  a  proportionate  dose  of  vitamine  for  a  man  weighing 
122  pounds  would  not  exceed  10  grams,  which  could  easily  be  taken  in 
capsule  or  other  form  for  therapeutic  or  preventive  purposes.  It  is  now 
to  be  hoped  that  the  isolation  of  vitamines  from  other  food  products  rich 
in  thoni  will  soon  be  accomplished. 

Relation  of  Vitamines  to  the  Phosphorus  Content  of  Foods. — Unfortu- 
nately, a  method  for  the  direct  isolation  of  vitamines  from  natural  foods 
has  not  been  devised,  as  in  the  case  of  yeast.  However,  the  phosphorus 
content  of  natural  foods  seems  to  furnish  a  fairly  accurate  index  of  the 
relative  percentage  of  vitamines  present.  Voegilin,  Myers  and  Sulli- 
van (54)  have  been  able  to  determine  that  while  phosphorus  does  not  form 
a  component  part  of  the  vitamine  molecule,  yet  it  seems,  according  to 
their  views,  that  the  distribution  of  phosphorus  and  vitamines  within  the 
grain  runs  practically  parallel. 

Tibbles(55)  in  summing  up  the  arguments  of  Sehauman  in  favor  of 
the  phosphorus  deficiency  theory  as  a  factor  in  the  causation  of  deficiency 
diseases  records  the  following:  (a)  that  foods  which  cause  beriberi,  ship 
beriberi,  scurvy  and  infantile  scurvy  are  deficient  in  organic  phosphorus, 
and  (b)  that  the  diseases  are  cured  by  foods  rich  in  organic  phosphorus 
compounds.  It  is  probable  that  different  gi-oups  of  organic  phosphonis 
compounds  serve  different  purposes  in  the  organism,  and  that  their  ab- 
sence leads  to  different  diseases.  Deficiency  of  one  organic  group  may 
cause  beriberi  in  adults,  and  deficiency  of  another  group  may  cause  rickets* 
and  infantile  scurvy.  Children  fed  with  boiled  or  condensed  milk  some- 
times develop  scurvy-rickets.  When  milk  is  boiled  it  is  to  some  extent 
denatured;  the  organic  compounds  of  phosphorus  are  more  or  less  de- 


234      SIGNIFICANCE    OF    LIPOIDS    AND    VITAMINES 

stroyed.  Bunge  says  lecithin  is  destroyed  at  70°  C.  (140°  F.).  Rac- 
zowski  found  25  per  cent  was  destroyed  at  60°  C,  28  per  cent  at  95°  C, 
and  30  per  cent  at  110°  C.  Rickets  is  common  in  children  of  the  poor  in 
England,  less  common  in  the  highlands  of  Scotland  and  in  Ireland.  Many 
English  children  are  fed  on  skim  milk  containing  only  0.03  per  cent  of 
phosphorus  pentoxid  (P2O5),  white  bread  containing  0.2  per  cent  phos- 
phorus pentoxid  and  margarin.  A  Scotch  highland  child  gets  oatmeal 
containing  0.9  per  cent  phosphorus  pentoxid  and  new  milk  containing  1 
per  cent  phosphorus  pentoxid,  and  German  children  get  rye  bread  con- 
taining 1  per  cent  phosphorus  pentoxid. 

Edie  and  Simpson(5G)  found  that  these  diseases  are  not  cured  by  the 
addition  to  the  food  of  carbohydrates,  inorganic  phosphates,  egg  albumin 
and  synthetic  organic  phosphorus  compounds,  such  as  glycerophosphates, 
albumin,  metaphosphates,  etc.,  nor  did  these  substances  prevent  polyneu- 
ritis in  birds.  But  polyneuritis  in  birds  is  prevented  and  cured  by  the 
addition  to  the  diet  of  substances  rich  in  organic  phosphorus,  such  as  rice 
bran,  wheat  bran,  yeast,  katjang  idjoe  beans,  testicular  extract,  pancreas, 
etc.,  in  such  proportion  as  to  raise  the  daily  income  of  phosphorus  in  the 
food  to  the  normal  amount.  The  daily  normal  requirement  for  a  man  is 
2  grams,  for  a  dog  0.5  gTam.  It  was  found  by  Eraser  and  Stanton(57) 
that  the  beriberi  causing  pjwer  of  rice  is  associated  with  the  removal  of 
the  phosphorus-containing  substances  by  polishing  the  grain.  They  have 
definitely  proved  that  no  rice  connected  with  the  outbreak  of  beriberi  con- 
tained more  than  0.26  per  cent  of  phosphorus  pentoxid,  that  rice  which 
contained  0.37  j)er  cent  of  phosphorus  pentoxid  did  not  cause  beriberi,  and 
the  consumption  of  rice  containing  0.4  per  cent  of  phosphorus  pentoxid  is 
perfectly  safe. 

More  recent  evidence  is  afforded  by  a  Siamese  Government  Report  on 
beriberi  by  Highet,  which  furnishes  conclusive  evidence  that  the  use  of  rice 
containing  less  than  0.4  per  cent  of  phosphorus  pentoxid  is  likely  to  cause 
beriberi.  If  not  milled  so  as  to  reduce  the  phosphorus  pentoxid  below  this 
standard,  Siamese  rice  is  a  safe  food.  Acting  on  this  finding,  the  Sia- 
mese Government  pushed  the  use  of  under-milled  rice  in  all  government 
institutions  and  the  gendarmerie,  and  has  practically  done  away  with  beri- 
beri among  these  people,  and  an  attempt  is  now  being  made  to  enforce  its 
use  in  the  army  and  navy. 

Fraser  and  Stanton  (58),  basing  their  opinion  on  a  large  number  of  ob- 
servations and  analyses,  conclude  that  rice  with  a  phosphorus  pentoxid 
(P2O5)  content  below  0.4  per  cent  is  deficient  in  vitamines.  Myers  and 
Voegtlin  adopted  this  method  to  correlate  the  vitamine  content  of  wheat 


VITAMINES 


235 


and  corn  products,  and  came  to  the  same  conclusion,  that  the  identical  rela- 
tion exists  between  the  phosphorus  pentoxid  content  of  these  cereals  as 
exists  in  the  case  of  rice.  To  arrive  at  this  conclusion,  they  conducted  a 
series  of  experiments  on  fowls,  the  classical  animal  for  determining  the 
vitamine  content  of  foods.  It  is  well  known  that  fowls  will  live  in  perfect 
health  for  many  months  on  an  exclusive  diet  of  wheat  or  corn. 

Whole  corn  meal,  or  the  so-called  "water-ground"  corn  meal,  furnishes 
a  Avcll-balanced  dietary  for  fowls,  but,  on  the  other  hand,  it  is  a  matter 
of  recorded  fact  that  fowls  fed  on  highly  milled  products  from  wheat,  corn 
or  rice  will  die  within  a  month  or  six  weeks  from  polyneuritis.  The  fol- 
lowing table  from  Public  Health  rejwrts  graphically  illustrates  the  findings 
of  Voegtlin  and  his  coworkers: 

TABLE  SHOWING  THE  EFFECT  OF  WHOLE  GRAIN  AND  HIGHLY 
MILLED  CEREALS  ON  FOWLS 


Variety  of  Cereals,  Whole 
AND  Highly  Milled 


Wheat  bread  made  from  highly 
milled  flour 

Whole  wheat 

Corn  grits  (highly  milled).. 

Corn  grits  (highly  milled) 

Corn  meal  (highly  milled) 

Corn  meal  (old  fashioned  rock 
ground) 

Corn  meal  (rock  ground) 

Corn  germ 

Corn,  whole 


Per  cent  of 

P2O5 

dry  food 

Number  of  days  required  for  ap- 
pearance of  poljnieuritis  in  fowls 
fed  exclusively  on  this  food 

0.114 
1.120 
0.169 
0.210 
0.30 

0.659 
0.772 
2.816 
0.760 

20-32  days 

No  sjTuptoms  developed 

23-50  days 

30  days 

35  days 

Remained  well 
Remained  well 
Remained  well 
Remained  well 

]\Iyers  and  Voegtlin  conclude  from  their  experiments  the  following 
provision  standard,  phosphorus  pentoxid  content  for  wheat,  flour,  com 
meal  and  grits ;  for  corn  products,  the  minimum  phosphorus  pentoxid 
content  should  not  fall  below  0.50  per  cent  and  for  wheat  flour  not  below 
1  per  cent,  as  a  safe  index  for  arriving  at  the  relative  amounts  of  vita- 
mines  present.  These  investigators  consider  the  determination  of  the 
phosphorus  pentoxid  index  of  considerable  value  in  all  cereal  products  with 
the  exception  of  the  so-called  "self-raising  flours."  These  latter  products 
contain  baking  powders,  composed  largely  of  phosphates.  Of  recent  years 
certain  factors  have  arisen  which  exert  a  tendency  to  limit  the  vitamine 
content  of  the  dietary  of  certain  classes  of  our  rural  population.  Changes 
in  the  economic  conditions  of  food  production  and  the  methods  of  cooking 


236       SIGNIFICANCE    OF    LIPOIDS    AND    VITAMINES 

seem  to  reduce  the  vitamine  content  of  the  diet  of  a  large  number  of  per- 
sons almost  to  the  danger  point.  One  factor  involved  in  the  reduction  of 
the  vitamine  content  of  bread,  especially  cornbread,  is  the  almost  universal 
use  of  baking  soda  as  a  leavening  in  bread  making.  It  has  been  clinically 
demonstrated  on  animals  that  bread  made  from  highly  milled  corn  meal, 
to  which  milk  and  soda  is  added  for  leavening,  lessens  the  high  initial 
content  of  the  antiueuritic  substance  during  the  process  of  baking  as  a  re- 
sult of  the  destructive  action  of  the  alkali  contained  in  the  soda. 

We  pointed  out  in  the  section  on  Bread  Making  (Volume  I,  Chaj^ter 
XIII,  page  386)  that,  where  bicarbonate  of  soda  and  milk  are  used  for 
leavening  during  the  process  of  cooking,  the  sodium  bicarbonate  was  con- 
verted into  a  strong  alkali,  which  is  not  a  food  product.  Prior  to  the  in- 
troduction of  the  patent  roller-process  of  grinding  grains,  cornbread  made 
from  the  water-ground  meal  was  mixed  with  salt  and  water  and  it  yielded 
a  wholesome  bread ;  but  simultaneously  with  the  introduction  of  highly 
milled  corn  meal,  it  was  found  that  when  this  product  was  mixed  with  salt 
and  water,  it  did  not  yield  bread  of  the  same  lightness  as  the  old-fashioned 
water-ground  meal.  It  then  became  necessary  to  resort  to  artificial  leav- 
ening, and  sodium  bicarbonate  became  a  popular  household  remedy. 
Bread,  made  by  means  of  bicarbonate  of  soda  and  salt,  under  present  con- 
ditions, has  a  distinctly  alkaline  taste  and  reaction.  The  usual  method 
of  preparing  bread  from  bolted  corn  meal  is  to  mix  it  with  water  and  add 
a  small  quantity  of  shortening  and  bicarbonate  of  soda  for  leavening.  The 
resulting  mushy  mixture  is  baked  in  an  oven,  the  high  temperature  of 
which  liberates  carbon  dioxid  from  the  sodium  bicarbonate,  and  the  latter 
is  transformed  into  sodium  carbonate,  a  strong  alkali.  Voegtlin  and  Sul- 
livan (50)  recently  demonstrated  that  the  action  of  this  alkali  is  destruc- 
tive to  vitamines(60).  It  was  then  definitely  proved  that  the  "accessory 
substances"  lose  their  physiological  activity  when  exposed  to  alkalies,  and 
more  especially  under  the  influence  of  the  high  temperature  of  a  baking 
oven.  Cornbread,  prepared  from  the  old-fashioned  water-ground  meal, 
sweet  milk  and  soda,  when  forming  the  exclusive  diet  of  chickens,  soon 
leads  to  the  development  of  symptoms  of  polyneuritis,  but  on  the  other 
hand,  bread  prepared  from  the  old-fashioned  water-ground  corn  meal,  but- 
termilk and  salt  (NaCl)  does  not  give  rise  to  any  polyneuritic  symptoms, 
and  the  fowls  seem  to  maintain  perfect  health.  In  contrast  to  the  de- 
structive action  of  alkalies  on  vitamines  brought  about  by  the  use  of  bicar- 
bonate of  soda  in  bread-baking,  it  is  necessary  to  emphasize  the  fact  that 
the  old-fashioned  way  of  combining  baking  soda  with  sour  buttermilk  in 
the  preparation  of  bread  is  a  perfectly  harmless  procedure,  provided  that 


VITAMINES 


237 


sufficient  sour  milk  is  added  to  neutralize  the  alkalinity  of  the  baking  soda. 
The  following  table  worked  out  by  Voegtlin  emphasizes  the  destructive 
action  of  baking  soda  on  the  vitamine  content  of  nornbread.     He  fed  a 
coop  of  chickens  on  cornbread  having  the  following  composition : 

600  gm.  of  corn  meal 
800  c.c.  swl^et  milk 
10  gm.  of  baking  soda 

with  the  following  result : 


Number  of  days  be- 

Number of  days  be- 

Laboratory Num- 

fore appearance  of 

Laboratory  numbers 

fore  appearance  of 

bers  of  Animals 

polyneuritis    after 

of  animals 

polyneuritis    after 

feeding  was  begun 

feeding  was  begun 

31 

13 

37      • 

19 

32 

14 

38 

21 

33 

27 

39 

18 

34 

13 

40 

16 

35 

22 

36 

14 

Average 

ii 

Vitamines  and  Pellagra — The  appearance  of  pellagra,  a  disease  of  the 
peripheral  nervous  system,  has  recently  stimulated  much  research  in  the 
Southern  States  as  to  its  causation  and  treatment.  Voegtlin  believes  that 
the  dietary  of  pellagrins  is  deficient  in  vitamines.  It  is  known  that  pel- 
lagrins subsist  on  a  dietary  that  is  not  rich  in  vitamines.  The  recent 
investigations  made  by  Goldberger  and  other  officers  of  the  Public  Health 
Service  seem  to  bear  out  this  assertion.  The  foodstuffs  forming  their 
principal  alimentation  consist  of  highly  milled  cereals,  principally  corn, 
and  fat  pork,  in  addition  to  carrots  and  turnips  and  similar  vegetables. 
It  is  also  believed  that  baking  soda,  which  is  used  as  a  leavening  for 
making  cornbread,  tends  to  further  lower  the  vitamine  content. 

From  the  available  data  at  hand,  one  may  conclude  that  the  prevalence 
of  pellagra  in  the  South  is  due  to  several  factors :  (a)  the  highly  milled 
wheat  and  corn  products  which  are  undoubtedly  deficient  in  vitamines; 
(b)  the  preparation  of  bread  from  both  highly  milled  flour  and  com  meal 
by  using  baking  soda  for  leavening,  without  buttermilk  or  tartaric  acid, 
which  permits  the  deleterious  effect  of  the  strong  alkali  to  destroy  the 
vitamine  content  of  the  food ;  (c)  changes  in  the  economic  conditions  of 
the  population,  and  in  food  production  and  supply — all  of  which  seer"  to 
exert  an  unfavorable  influence  on  the  dietary  of  the  poorer  people.  The 
increased  cost  of  living  places  beyond  their  reach  the  more  expensive  foods 


238       SIGNIFICANCE    OF    LIPOIDS    AND    VITAMINES 

— meat,  eggs,  milk,  etc. — having  a  fairly  high  vitamine  content,  which 
are  not  so  liberally  used  as  heretofore,  and  a  reduction  in  the  amount  of 
these  important  foods,  therefore,  reduces  the  vitamine  content  of  the 
ration.  During  the  past  ten  years,  the  cost  of  food  has  increased  out  of 
proportion  to  the  increase  in  wages,  and  pellagra  has  likewise  increased 
during  this  decade.  • 

The  reduction  of  the  vitamine  content  of  the  diet  of  pellagrins  is  due 
(a)  to  the  reduction,  for  economic  reasons,  of  certain  aliments  in  the 
dietary,  of  vitamine — rich  foods,  such  as  fresh  milk,  eggs  and  meats;  (fc) 
the  introduction  of  highly  milled  cereals,  and  (c)  to  the  use  of  baking 
soda  as  a  leavening,  which  exerts  a  destructive  action  on  the  vitamine 
content  of  bread. 

The  fact  that  the  above-mentioned  influences,  which  have  undoubtedly 
reduced  the  vitamine  content  of  the  diet,  made  themselves  felt  a  relatively 
short  time  before  the  rapid  increase  in  pellagra  in  the  South,  furnishes  con- 
siderable evidence  in  favor  of  the  vitamine-deficiency  theory  of  pellagra. 


KEFERENCES 

1.  McCoLLUM  and  Davis.     The  Necessity  for  Certain  Li^xtids  in  Diet 

During  Growth,  J.  Biol,  Chem.,  pp.  15-167. 

2.  Landers.    Biochem.  J.,  1913,  p.  78. 

3.  McCoLLUM.    J.  Biol.  Chem.,  1912,  11,  vol.  xii. 

4.  VoEGTLTN  and  Sullivan.     Science,  1913,  pp.  672,  964. 

5.  LoEB  and  Beutner.    Ihid.,  pp.  672-673. 

6.  LiLLiE.     Ibid.,  p.  967. 

7.  Funk,  Casimik.     Die  Vitamine,  Wiesbaden,  1914. 

8.  Cooper.     J.  Hyg.,  1912,  vol.  xii,  p.  436. 

9.  VoEGTLiN,  Carl  (Prof,  of  Phar.  U.  S.  P.  H.  S.).    Proc.  Am.  Sec. 

Biol.  Chem.,  1915. 

10.  Funk,  Casimir.    Die  Vitamine,  1914. 

11.     .    Ztschr.  f.  Physiol.  Chem.,  1914,  vol.  Ixxxix,  p.  378. 

12.  Braddon  and  Cooper.     J.  Hyg.,  1914,  vol.  xiv,  p.  351. 

13.  VoEGTLiN,  Carl.     U.  S.  Pub.  Health  Service,  J.  Washington  Acad. 

of  Sci.,  Oct.,  1916,  vol.  vi,  No.  16. 

14.  Sullivan  and  Voegtlin.    TJ.  S.  Pub.  Health  Service,  Proc.  Amer. 

Soc.  Biol.  Chem.,  1915. 

15.  Voegtlin,  Carl.     J.  Washington  Acad,  of  Sci.,  Oct.,  1912,  vol.  vi. 

No.  16. 


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IG.      TijAiBE.     Biochem.  Ztschr.,  1901), 

17.  Stepp,  \V.     Biochem.  Ztschr.,  22-4.52. 

18.  Funk,  C,  and  iMacalllm,  A.  Biiuce.     Ztschr.  f.  Physiol.  Chem., 

vol.  xcii,  p.  13. 

19.  Stepp,  W.     Deiitsch.  med.  Wchschr.,  1914,  40-892. 

20.  Funk.     Die  Rolle  der  Vitamine  beim  Kohlenhydrat-Stoffwechsel, 

Ztschr.  f.  Physiol.  Chem.,  1914,  vol.  Ixxxix,  p.  378. 

21.  Funk,  C.     Vitamines  in  Digestion,  Proc.  Phys.  Soc,  Dec.  13,  1913. 

22.  Funk  and  Macallum.     Studies  on  Growth,  J.  Biol.  Chem.,  1915, 

vol.  xxiii,  p.  413,  etc. 

23.  VoEGTLiN,  Carl.     Proc.  Amer.  Soc.  Biol.  Chem.,  1915. 

24.     .     Ihid. 

25.  VoEGTLiN,  Carl.    J.  Washington  Acad,  of  Sciences,  vol.  vi,  !N'o.  16. 
2G.     Funk.     Pnb.  Health  Reports,  April  14,  1910. 

27.  Osborne  and  Wakeman.     J.  Biol.   Chem.,   May,   1915,  vol.  xxi, 

No.  1. 

28.  McCoLLUM,  E.  v.,  and  Davis,  M.     J.  Biol.  Chem.,  1913,  vol.  xv, 

p.  167. 
Osborne  and  Mendel.    Ihid.,  1913-1914,  vol.  xv,  p.  311;  vol.  xvi, 

p.  423. 
McCoLLUM  and  Davis.    Proc.  Soc.  Exper.  Biol,  k  Ifed.,  1914,  vol. 

xi,  p.  101. 
Osborne  and  Mendel.     J.  Biol.  Chem.,  1914,  vol.  xvii,  p.  401. 
MoCoLLUM  and  Davis.     Ihid.,  1914,  vol.  xix,  p.  245. 

29.  Osborne,  T.  B.,  and  ^Fexdel,  L.  B.     Feeding  Experiments  with 

Isolated  Food  Substances,  Carnegie  Inst,  of  Wash.  Pnb.,  1911, 
No.  156,  pt.  ii,  p.  80.  See  also  Ztschr.  f.  Physiol.  Chem.,  1912, 
vol.  Ixxx,  pp.  315-316;  see  J.  Biol.  Chem.,  1909,  1910,  vols. 
vi  to  viii. 

30.  McCoLLUM,  E.  v.,  and  Davis.     Jour.  Biol.  Chem.,  1913,  vol.  x^^ 

31.  Funk,  C,  and  ^NFacallum,  A.  B.     Ztschr.  f.  physiol.  Chem.,  1914, 

vol.  xcii,  p.  13. 

32.  Funk,  C,  and  ^Iacallum,  A.  B.    J.  Biol.  Chem.,  vol.  xxiii,  p.  416; 

vol.  xxvii,  p.  51. 

33.  Wilcox,  William  Henry   (London,  Lieut.   Col.  R.A.M.C.).     In 

an  article  on  beriberi  with  special  reference  to  prophylaxis  and 
treatment.  Lancet,  March  11,  1916. 

34.  Hopkins,  F.  Gowland.     Feeding  Experiments  illustrating  the  im- 

portance of  accessory  factors  in  Normal  Dietary,  J.  Physiol., 
1912,  pp.  425-460,  Biochem.  J.,  1913,  p.  97. 


240      SIGNlFICAIs^CE    OF   LIPOIDS   AND   VITAMINES 

35.     Funk,  Casimik.     The  Role  of  the  Vitamiues  in  the  Digestion  and 

Application  of  Food,  Proc.  Physiol.  Soc,  Dec.  13,  1913. 
3G.     Little.     J.  Am.  Med.  Assn.,  1912,  vol.  Iviii,  p.  2029. 

37.  Fkaser  and  Stanton.     Studies  from  the  Inst,  for  Medical  Re- 

search, Federated  Malay  States,  1909,  No.  10. 

38.  Stkong  and  Ckowell.    The  Etiology  of  Beriberi,  Philippine  J onr. 

Sc,  1912,  vol.  vii,  p.  271. 

39.  Van  Leent.    Arch,  de  med.  nav.,  Oct.,  1867,  p.  241 ;  Communica- 

tion sur  le  beriberi,  Cong.  Internat.  d.  sc.  med.  Amst.,  1S80, 
vol.  vi,  p.  170,  etc. 

40.  VoRDEEMAN.     Oudcrzock  naar  het  verband  tusschen  den  aard  der 

rijstvoeding  in  de  gevangenissen  op  Java  en  Madoera  en  het 
voorkomen  van  beriberi  onder  de  geinterneerden,  Bavaria,  1897. 

41.  Takaki.     Three  lectures  on  the  Preservation  of  Health  Among  the 

Personnel  of  the  Japanese  Navy  and  Army,  Lancet,  London, 
1906,  vol.  i,  pp.  1369,  1451,  1520,  etc. 

42.  Fletcher.     Rice  and  Beriberi,  J.  Trop.  Med.  &  Hyg.,  1909,  vol. 

xii,  p.  127;  Lancet,  London,  1907,  vol.  i,  p.  1776,  etc. 

43.  Highet.     Beriberi  in  Siam,  Philippine  J.  Sc,  1910,  vol.  v,  p.  73. 

44.  Heiser,  V.  G.     Practical  Experiments  with  Beriberi  and  Unpol- 

ished Rice,  Phil.  Jour.  Sc,  1911,  vol.  vi,  p.  1237;  Practical 
Experiments  with  Beriberi  and  Unpolished  Rice,  Phil.  J.  Am. 
Med.  Assn.,  April  29,  1911,  p.  1238. 

45.  Tiieze.     Note  sur  le  beriberi  a  poulo-condore,  Ann.  d'hyg.  et  de 

mod.  colon.,  1910,  vol.  xiii,  p.  16. 

46.  CiiAMBERLAiN.     The  Eradication  of  Beriberi  from  the  Phil.  Scouts 

by  Means  of  a  Simple  Change  in  Their  Dietary,  Philippine  J. 
Sc,  1911,  vol.  vi,  p.  133. 

47.  Vedper,  E.  B.    Beriberi,  pub.  by  William  Wood  &  Co.,  New  York, 

1913. 

48.  Vedder  and  Williams.     Concerning  the  beriberi  preventing  sul> 

stances  or  vitamine  content  in  rice  polishings,  Phil.  J.  Sc,  1913, 
vol.  iii,  p.  175. 

49.  V  iDDER  and  Clark.     Polyneuritis  Gallinarum,  a  Fifth  Contribu- 

tion to  the  Etiology  of  Beriberi,  Philippine  J.  Sc,  1912,  vol. 
vii,  p.  423. 

50.  Wood.     Pellagra,  J.  Am.  Med.  Assn.,  1917. 

51.  Public  Health  Reports,  1916. 

52.  Bulletin  Hygienic  Laboratory,  Washington,  D.  C,  Feb.  18,  1916. 

53.  Lloyd,  John.    Editorial,  New  York  Med.  J.,  March  18,  1916. 


BIBLIOGRAPHY  241 

54.  VoEGTLiN,  Myers  and  Sullivan.     Hyg.  Lab.  Pub.  Health  Rep., 

April  14,  1916. 

55.  TiBBLEs,  William.     Food  in  Health  and  Disease. 

56.  Edie  and  Simpson.     Brit.  Med.  J.,  1911,  vol.  i,  p.  1422. 

57.  Erasek  and  Stanton.     Studies  from  Inst.  Med.  Research,  Fed- 

erated Malay  States,  1909,  No.  10;  1911,  No.  12  j  Lancet,  1909, 
voL  i,  p.  451;  1911,  vol.  ii,  p.  1159. 
68.     Feasek  and  Stanton.     Lancet,  1915,  vol.  i,  p.  1021;  J.  Trop. 
Med.  &  Hyg.,  1911,  p.  333. 

59.  Voegtlin  and  Sullivan.     Proc  Amer.  Soc.  Biol.   Chem.,   1916, 

vol.  xvi,  p.  24. 

60.  Veddee  and  Williams.    Philippine  J.  Sci.,  1914,  vol.  viii,  p.  175. 

BIBLIOGRAPHY 

Davis.    The  Influence  of  Diet  on  Growth,  Biochem.  J.,  1913,  p.  167. 

Funk,  Casimik.  The  Probable  Role  of  Vitamines  in  the  Digestion  and 
Application  of  Food,  Proc,  Physiol.  Soc,  Dec.  13,  1913;  Die 
Vitamine,  Ihre  Bedeutung  fiir  die  Physiologic  und  Pathologic 
mit  besonderer  Beriicksichtigung  der  Avitaminosen,  1914. 

Gkijns.     Gen.  Tydsch.  voor  Nederl.  Indie,  1901,  vol.  xli. 

Hill  and  Flack.    Brit.  Med.  J.,  Sept.  16,  1911,  vol.  i,  p.  1311;  vol.  ii. 

Hopkins.  Feeding  Experiments  Illustrating  the  Importance  of  Acces- 
sory Factors  in  Normal  Dietary,  J.  Physiol.,  1912,  pp.  425-460. 

and  Neville.    The  Influence  of  Diet  on  Growth,  Biochem.  J., 

1913,  p.  97. 

OsBOKNE,  Thomas  G.,  and  Mendel,  Lafayette  B.  Science,  1913,  p. 
189. 

.     Feeding   Experiments   with   Isolated   Foodstuffs,    Carnegie 

Inst,  of  Washington,  Pub.  150,  Parts  1  and  2,  1911. 

Rosenheim.  Proc.  Physiol.  Soc,  1908,  vol.  liv;  J.  Physiol.,  1908,  vol. 
ii,  p.  317. 

Simpson  and  Webster.    Philippine  J.  Med.,  1912,  p.  42. 

TiBBLES.    Foods;  Their  Origin,  Composition  and  Manufacture,  p.  481. 

For  a  general  statement  with  literature,  see  Funk,  "Ergebnisse  der  Physi- 
ologie,"  1913,  vol.  xiii,  p.  125. 


CHAPTER   IX 

THE    CALORIC    METHOD    OF   FEEDING 
WiNFiELD  S.  Hall,  PhD.,  :Nr.D. 


Every  hill  of  fare  should  be  based  upon  calorimetric  experimentation;  the 
practical  trophodynamic  consideration  of  the  foodstuffs;  due  cognizance  of  the  ail- 
ment of  the  patient,  and  no  bill  of  fare  should  ever  be  a  theoretical  prescription 
culled  from  lists. 

Food  as  a  Source  of  Heat  and  Growth :  Introductory ;  Unit  and  Method  of 
Measurement;  Heat  by  Combustion  of  Various  Substances  and  Foods; 
Standard  and  Sample  Dietaries;  Caloric  Values  of  Ingested  Foods; 
Constructive  and  Fuel  Foods;  Caloric  Requirement  of  Man;  Calorific 
Value  of  Excretory  Products;  Physiological  Food  Value. 

Calculation  of  Fuel  Values  of  Food:  Chemical  Analyses  of  Foods;  Method  of 
Reckoning  the  Protein,  Fat  and  Carbohydrate  Rations  for  Diets  of 
Definite  Energy  Values. 

Factors  (Joverning  the  Amount  of  Food  Required:  Amount  of  Heat  Lost  by 
Body;  Weight  of  Body;  Age;  Sex;  Kind  of  Work;  Choice  of  Food; 
Intensity  of  Muscular  Activity. 

Regulation  of  Body  Temperature:  Physical  Heat  Regulation;  Chemical  Heat 
Regulation;  The  Surface  Areas  of  the  Skin  in  Heat  Regulation;  Regu- 
lation of  Heat  Loss;  Production  of  Heat  during  Rest;  Resume. 


FOOD    AS   A   SOURCE    OF    HEAT    AND    GROWTH 

Introductory. — Probably  no  single  contribution  to  tropliodynamics  has 
boen  more  fruitful  in  its  consequence  than  the  calories  idea.  It  was  no 
small  achievement  to  put  the  body's  need  for  physiological  fuel  upon  a 
definite  basis  and  to  give  a  concrete  significance  to  the  trophodynamic 
factor  in  nutrition.  Possibly  in  the  remote  past,  Nature's  scheme  for 
feeding  man  did  not  contemplate  the  accurate  measuring  of  his  food, 
other  than  to  provide  him  with  healthy,  normal  instincts.  At  the  present 
age,  however,  food  requirements  have  become  a  matter  of  accurate  estima- 
tion rather  than  animal  intuition.  Under-nutrition  can  be  demonstrated 
by  direct  dieting  investigations,  the  increased  demands  for  food — fuel  for 

243 


244  THE    CALORIC    METHOD    OF    FEEDING 

the  working  man,  as  well  as  the  relative  abnndance  of  the  ration  for  tlie 
infant  at  different  stages  of  growth,  need  no  longer  remain  veiled  in  the 
mystery  of  uncertainty. 

The  past  two  decades  have  witnessed  the  developments  of  scientific 
methods,  rendered  possible  by  really  accurate  investigations  relative  to  the 
trophodynamics  of  foods.  "They  show,"  declares  Prof.  Armsby,  "that 
the  transformations  of  chemical  energy  into  heat  and  work  in  the  animal 
body  take  place  according  to  the  same  general  laws  and  with  the  same 
equivalencies  as  in  our  artificial  motors  and  in  lifeless  matter  generally. 
The  great  law  of  the  conservation  of  energy  rules  in  the  animal  mech- 
anism, whether  in  man,  carnivora  or  herbivora,  just  as  in  the  engine.  The 
body  neither  manufactures  nor  destroys  energy.  All  that  it  gives  out  it 
gets  from  its  food,  and  all  that  is  supplied  in  its  food  is  sooner  or  later 
recovered  in  some  form.  We  are  fully  justified,  therefore,  in  speaking 
of  the  food  as  body  fuel,  and  in  our  studies  of  its  utilization  we  may  be 
confident  that  any  food  energy  which  does  not  reappear  in  the  form  of 
heat  or  work  has  not  been  lost,  but  has  been  stored  up  in  the  body  as  the 
chemical  energy  of  meat,  fat,  etc.,  which  may  later  serve  to  supply  food- 
energy  to  the  human  body." 

Atwater(l),  Langworthy(2)  and  their  coworkers  have  collected  data 
and  published  a  resume  of  almost  all  the  known  metabolism-experiments 
of  value  in  determining  the  trophology,  trophodynamics  and  tropho- 
therapy  of  foodstuffs.  The  results  of  their  studies  in  metabolism  exceed 
by  far  those  of  any  other  observers  in  any  other  country.  The  scope  and 
importance  of  their  experimental  work,  as  stated  by  Atwater,  the  leading 
American  authority  on  this  science,  is  as  follows : 

The  science  of  nutrition  must  be  studied  from  the  standpoints  of  the  metabolism 
of  matter  and  energy,  if  its  fundamental  laws  are  to  be  thoroughly  learned.  The 
ideal  experiment  for  the  determination  of  metabolic  balance  would  include,  (a)  a 
respiration  experiment,  (6)  a  dietary  study,  and  (c)  a  digestion  experiment  in 
which  the  thermal  values  of  food  and  excreta  are  determined.  It  would  also  in- 
clude a  measurement,  with  a  calorimeter  or  by  other  suitable  means,  of  the  heat 
produced  in  the  organism.  If  work  is  also  performed,  it  must  also  be  measured. 
No  experiment  has  yet  been  made  which  reaches  this  ideal.  More  often  special 
problems  connected  with  metabolism  have  been  the  subject  of  investigation,  such 
as  the  following:  The  functions  of  the  nutrients  of  food;  the  formation  of  fat 
from  protein  and  from  carbohydrates;  the  digestibility  of  foods  of  various  kinds; 
the  isodjTiamic  values  of  nutrients;  the  fuel  value  (potential  energy)  of  food;  the 
influence  on  metabolism  of  various  diseases,  of  alcohol,  drugs,  condimentn,  and  the 
like,  and  of  various  forms  of  treatment,  medical  or  otherwise,  as  for  instance,  hot 
water  baths ;  the  influence  of  prolonged  hunger  or  thirst  on  metabolism ;  and  the 
quantities  of  nutrients  consumed  'and  appropriate  for  people  of  different  classes. 


FOOD  AS  A  SOUECE  OF  HEAT  ANJ)  GHOWTH        245 

occupations,  and  conditions,  and  for  animals  of  different  kinds  or  animals  fed  for 
different  economic  purposes. 

The  quality  and  quantity  of  diet  exert  a  far-reaching  influence  upon 
the  development  of  the  race,  an  influence  which  is  readily  observed  in  the 
physical  well-being  associated  with  an  adequate  supply  of  suitable  food. 
The  problems  of  dietetics  are  of  great  intricacy,  for  no  definite  food  or 
combinations  of  foods,  can  be  regarded  as  suitable  for  different  people,  or 
for  the  same  individual  under  different  circumstances.  The  application 
of  experimental  research  in  trophotherapy,  as  in  other  branches  of  science, 
has  yielded  some  insight  into  the  general  principles  which  govern  the 
nutrition  of  man. 

One  may  well  ask  the  question,  then:  "Why  do  physicians  take  so 
much  care  in  measuring  the  exact  dosage  of  drugs  which  are  administered 
only  occasionally,  and  give  such  little  attention  to  measuring  their  food 
prescriptions  which  are  to  be  followed  daily  ?"  A  physician  who  instructs 
his  patients  to  take  "a  little"  strychnia  or  a  "big  dose"  of  calomel,  etc., 
would  be  regarded  as  criminally  negligent,  yet,  in  prescribing  diet,  this 
is  just  the  kind  of  advice  that  physicians  usually  give.  It  is  rather  para- 
doxical that  a  question  which  so  intimately  engages  the  attention  of  man- 
kind, like  food  and  drink,  has  been  given  so  little  attention  by  the  medical 
profession.  The  study  of  the  therapeutic  indications  of  food  is  a  question 
which  will  demand  the  attention  of  the  physician  of  the  future.  He  will 
find  specific  medication — theoretically  speaking — in  the  so-called  "spe^ 
cific  values"  of  the  articles  of  nutrition  or  aliments.  It  is  no  longer  a 
question  that  certain  diseases  can  be  successfully  treated  by  the  adminis- 
tration of  properly  selected  and  prepared  articles  of  diet  which  have  a 
distinctively  active  or  medicinal  influence  over  certain  pathologic  condi- 
tions. In  many  instances  a  clear  understanding  of  the  proper  kind  and 
proper  dosage  of  food  is  more  important  to  the  physician  than  any  knowl- 
edge of  the  use  of  drugs.  The  appreciation  of  the  physiological  demands 
of  the  organism  necessitates  the  recognition  of  both  quantitative  and  quali- 
tative needs.  If  we  would  be  able  to  give  our  patients  the  proper  advice, 
we  must  carefully  study  foodstuffs,  their  composition,  their  preparation, 
their  digestibility  and  their  trophotJierapeutic  effects,  which  is  the  science 
that  deals  with  the  treatment  of  disease  with  food.  Trophodynamics 
deals  with  the  science  of  the  powers  and  effects  of  foods  Trophology  is 
the  science  of  the  nature  and  properties  of  materials  that  are  used  as 
food.  Since  our  knowledge  of  the  pathogenesis  of  a  large  number  of  dis- 
eases is  imperfect,  we  are  not  in  a  position  at  the  present  time  to  lay  down 

definite  rules  for  the  treatment  and  cure  of  disorders  that  are  due  to  a 
116 


246  TTTR    rALOKIC    :N[ETH0D    OF    FEEDING 

constitutional  or  nutritional  nature,  except  in  a  very  limited  number  of 
cases. 

Unity  and  Method  of  Measurement. — The  unit  of  measure  to  detei-mine 
the  fuel  value  of  foods  is  the  calorie.^  It  may  be  defined  as  that  amount 
of  heat  required  to  raise  the  temperature  of  one  kilogram  of  water  to  1 
degree  Centigrade.  To  determine  the  fuel  value  of  any  food,  that  is,  to 
calculate  the  amount  of  energy  liberated  by  the  burning  of  a  given  quan- 
tity of  combustible  material,  we  use  the  instrument  called  the  calorimeter. 
Various  forms  of  calorimeter  have  been  devised,  one  of  the  best  being  the 
bomb  calorimeter  devised  by  Berthelot.  This  instrument  and  the  method 
of  its  use  have  been  fully  described  by  Atwater  and  Snell(3).  "In  out- 
line, it  consists  of  a  heavy  steel  bomb  with  a  platinum  or  gold-plated 
copper  lining  and  a  cover  held  tightly  in  place  by  means  of  a  strong  screw 
collar.  A  weighed  amount  of  sample  is  placed  in  a  capsule  within  the 
bomb,  which  is  then  charged  with  oxygen  to  a  pressure  of  at  least  20  atmos- 
pheres (300  pounds  or  more  to  the  square  inch),  closed,  and  immersed  in 
a  weighed  amount  of  water.  The  water  is  constantly  stirred  and  its  tem- 
perature taken  at  intervals  of  one  minute  by  means  of  a  differential  ther- 
mometer capable  of  being  read  to  one  thousandth  of  a  degree.  After  the 
rate  at  which  the  temperature  of  the  water  rises  or  falls  has  been  deter- 
mined, the  sample  is  ignited  by  means  of  an  electric  fuse,  and,  on  account 
of  the  large  amount  of  oxygen  present,  undergoes  rapid  and  complete 
combustion.  The  heat  liberated  is  communicated  to  the  water  in  which 
the  bomb  is  immersed  and  the  resulting  rise  in  temperature  is  accurately 
determined.  The  thermometer  readings  are  also  continued  through  an 
"after  period,"  in  order  that  the  "radiation  correction"  may  be  calculated 
and  the  observed  rise  of  temperature  corrected  accordingly.  This  cor- 
rected rise,  multiplied  by  the  total  heat  capacity  of  the  apparatus,  and 
the  water  in  which  it  is  immersed,  shows  the  total  heat  liberated  in  the 
bomb.  From  this  must  be  deducted  the  heat  arising  from  accessory  com- 
bustions (the  oxidation  of  the  iron  wire  used  as  a  fuse,  etc.)  to  obtain  the 
number  of  calories  arising  from  the  combustion  of  the  sample." 

Through  the  aid  of  the  calorimeter  we  are  able  to  determine  not  only 
the  heat  given  off  by  the  combustion  of  any  oxidizable  material  such  as 
carbon,  fat,  starch,  albumin,  alcohol,  sugar,  etc.,  but  also  the  amount 
radiated  or  conducted  away  from  any  body,  for  example,  the  living 
animal.     Since  the  body  gets  its  energy  from  the  oxidation  of  the  same 


1  When  the  term  "calorie"  is  used  in  this  work  it  is  intended  to  refer  to  the 
greater  calorie,  i.e.,  the  amount  of  heat  necessary  to  raise  the  temperature  of  one 
kilogram  of  water  one  degree  Centigrade.  This  is  practically  the  same  as  the  amount 
of  heat  required  to  warm  four  pounds  of  water  one  degree  Fahrenheit. 


FOOD  A8  A  SOURCE  OF  ILKAT  AXI)  GROWTH 


247 


kind  of  compounds  wliicli  exist  in  foods,  that  is,  essentially  from  carbo^ 
hydrates,  fats,  proteins,  and  their  cleavage  products,  if  we  know  the  kinds 
and  amounts  of  foodstuffs  eaten  and  the  extent  to  which  they  are  oxidized 
in  the  body,  we  can  estimate  in  calories  the  amounts  of  energy  liberated. 


./.      2, 


Fl(i.  4. —  DlAGKA.M   OF  TIIK  HkNKDICT  "UnIVKRSAL"  OR  "Umt"  APPARATUS  FOR 
.MlJA.SURING    AnSORPTIOX  OF  OXYGKN  AXU  OUTl'LT  OF  C'AKBON  DlOXII). 

Heat  of  Combustion  of  Various  Substances  and  Foods — The  average 
results  of  calorimetric  combustion  show  for : 

Carbohydrates 4.1  calories  per  gram 

Fats 9.45     "  "       " 

Protein 5.65     "  "       " 

The  heat  of  combustion  of  various  substances  as  well  as  the  relation 
between  their  elementary  composition  will  be  made  clearer  by  the  study 
of  the  table  on  page  248  from  Sherman (4),  which  includes  the  number  of 
typical  compounds  found  in  food  or  formed  in  the  body: 


248 


THE    CALORIC    METHOD    OF    FEEDING 


flEAT  OF  COMBUSTION  AND  APPROXIMATE  ELEMENTARY 
COMPOSITION  OF  TYPICAL  COMPOUNDS 


Heat  of 
Combustion, 

Carbon, 

Hydro- 

Oxygen, 

Nitro- 

Sulphur, 

Phos- 
phorus, 
per  cent 

Calories 
per  gram 

per  cent 

gen, 
per  cent 

per  cent 

gen, 
per  cent 

per  cent 

Glucose 

3.75 

40.0 

6.7 

53.3 

Sucrose 

3.96 

42.1 

6.4 

51.5 

Starch [ 

Glycogen. . .  ) 

4.22 

44.4 

6.2 

49.4 

Body  fat 

9.60 

76.5 

12.0 

11.5 

Butter  fat ... . 

9.30 

75.0 

11.7 

13.3 

Edestin 

5.64 

51.4 

7.0 

22.1 

18.6 

0.9 

Legumin 

5.62 

51.7 

7.0 

22.9 

18.0 

0.4 

Gliadin 

5.74 

52.7 

6.9 

21.7 

17.7 

1.0 

Casein 

5.85 

53.1 

7.0 

22.5 

15.8 

0.8 

0.8 

Albumin 

5.80 

52.5 

7.0 

23.0 

16.0 

1.5 

Gelatin 

5.30 

50.0 

6.6 

24.8 

18.0 

0.6 

Creatin 

4.58 

42.5 

6.2 

14.1 

37.2 

Urea 

2.53 

20.0 

6.7 

26.7 

46.6 

The  following  table  from  Hall (5)  graphieall}'  expresses  the  calories 
represented  in  different  foods  and  other  substances  involved  in  the  proc- 
esses of  nutrition : 

TABLE  SHOWING  CALORIES  PER  GRAM  OF  DRY  SUBSTANCE 


1  Gram  dry  substance 


Heat  of  combustion 
in  calories 


Starch  or  glycogen 

Cane  sugar 

Dextrose 

Lactose 

Carbohydrates,  average;  absorbed  and  available 

Fat  (one  form) 

Fat  (another  form) 

Butter 

Fats,  average;  9.4;  absorbed  and  available 

Egg,  white 

Egg,  yolk 

Egg  average,  white  and  yolk 

Lean  beef 

Casein 

Vegetable  proteins 

Proteins,  average 

Protein,  unavailable  energy  (unabsorbed  or  unoxidized) 

Proteins,  available  energy  for  use  in  body 

Carbon,  per  gram 

Hydrogen,  per  gram 


4.182 
4.176 
3.940 
4.162 

4.0 

9.686 
9.423 
7.264 

9.0 

4.896 
6.460 
5.678 
5.656 
5.849 
5.500 
5.650 
1.650 

4.0 

8.080 
34.662 


FOOD  AS  A  SOURCE  OF  HEAT  AND  GROWTH 


249 


Standard  and  Sample  Dietaries — We  have  just  studied  ''heat  of  com- 
bustion and  approximate  elementary  composition  of  typical  compounds," 
together  with  the  "calories  represented  in  different  foods  involved  in  the 
process  of  nutrition,"  and,  before  entering  upon  a  consideration  of  the 
theoretical  requirements  of  individuals,  some  standard  dietaries  and  a 
few  examples  of  diets  consumed  by  people  of  different  classes  such  as  rep- 
resented in  the  table  ^  below  should  guide  us  in  arranging  a  diet  for  groups 
of  people  in  various  circumstances  and  following  varied  occupations : 

STANDARD  DIETARIES 


Standard  dietaries  and  others 


Protein, 
Grams 


Fat, 
Grams 


Carbo- 
hydrates, 
Grams 


Energy, 
Grams 


Standard  Diet:  Ranke's 

Moleschott's 

Pettenkof er  and  Voit's 

Cornet's 

Playfair's 

Parke's 

The  diet  of  Harvard  University  boat  crew . . 
Harvard  Freshman  boat  crew. . . 

Yale  University  boat  crew 

Harvard  University  boat  crew  (2d 

observation) 

Harvard  Freshmen  boat  crew  (2d 

observation) 

Yale  University  boat  crew  (2d  ob- 
servation)   

Captain  of  Harvard  crew 

Average  of  above  diets 

Football  team:  Connecticut 

Football  team:  California 

Professional  athlete 

Athletes  at  Helsingfors 

Brickmakers  in  Connecticut 

Mechanics  in  United  States 

Lumbermen  in  Maine 

United  States  Army  ration 

United  States  Navy  ration 

English  Royal  Engineers  in  active 
work 

English  soldiers  on  special  duty.  . . 

European  soldiers  in  Batavia 

Mechanics  in  Germany 

Farm  laborers  in  Austria 

Factory  operatives  in  Russia 

Mechanics  in  Sweden 


100 
130 
137 
120 
119 
127 
162 
153 
145 

160 

135 

171 
135 


135 

181 
270 
244 
217 
182 
222 
154 
206 
164 
143 

144 
190 
145 
136 
139 
159 
132 
189 


100 

84 

117 

60 

51 

99 

175 

223 

170 

170 

152 

171 

181 


177 

292 
416 
151 
259 
204 
265 
227 
387 
98 
184 

83 
58 

150 
79 

113 
62 
80 

110 


240 
404 
352 
500 
530 
397 
449 
468 
375 

448 

416 

434 

487 


440 

557 
710 
502 
431 
392 
758 
626 
963 
600 
520 

631 
510 
450 
497 
677 
977 
584 
714 


2,310 
2,970 
3,113 
3,007 
3,025 
3,172 
4,130 
4,620 
3,705 

4,075 

3,675 

4,070 
4,315 


4,085 

5,470 
7,885 
4,460 
5,070 
4,254 
6,484 
5,275 
8,140 
4,061 
5,000 

3,950 
3,426 
3,503 
3,000 
4,395 
5,235 
3,680 
4,725 


1  From   Bull.  45,  U.  S.  Dt'pt.  Agric,  and  various  other  sources. 


250  THE    CALORIC    METHOD    OF    FEEDING 

Caloric  Values  of  Ingested  Foods. — In  the  process  of  digestion  and 
absorption,  the  combustion  of  fats  and  carbohydrates  yields  products 
identical  with  those  in  the  calorimeter,  and  gives  out  an  equivalent 
amount  of  heat.  This  does  not  hold  true  with  protein,  however,  which 
in  the  bomb  turns  to  carbon  dioxid,  water  and  nitrogen,  but  in  the  body 
yields  no  free  nitrogen,  for  here  urea  and  other  organic  nitrogen  com- 
pounds are  excreted  as  end  products  of  protein  digestion  (see  Volume  I, 
Chapter  VII,  Physiology  and  Absorption).  From  this  data  it  will  be  seen 
that  these  organic  nitrogenous  end  products  which  are  combustible  result 
from  a  more  incomplete  oxidation  of  protein  in  the  organism  than  that 
occurring  in  the  bomb.  The  estimation  of  the  loss  of  potential  energy 
is  based  on  the  theory  that  the  total  quantity  of  nitrogen  excreted  from 
the  body  as  urea  would  amount  to  about  0.9  calories  per  gram  of  protein. 
However,  this  problem  is  not  as  simple  as  would  seem  at  first  sight,  for, 
owing  to  the  excretion  of  other  matter  (creatinin,  uric  acid,  and  the  like) 
of  higher  combustion,  the  real  loss  from  end  products  is  increased  to  the 
average  of  about  1,3  calories  per  gram  of  protein  disintegrated  in  the 
organism.  Therefore,  it  is  correctly  estimated  that  when  the  body  burns 
material  which  it  has  previously  absorbed  it  obtains: 

From  carbohydrates    4.1  calories  per  gram 

From  fats 9.35     "  "       " 

From  protein   (5.65—1.30).  4.35     "  "       " 

An  allowance  must  be  made,  however,  when  calculating  the  fuel  value 
of  food  to  allow  for  the  fact  that  a  part  of  each  of  the  materials  is  lost 
in  digestion,  so  that  the  approximate  values  of  a  mixed  diet  are: 

Carbohydrates  ...    2  per  cent  lost,  98  per  cent  absorbed 

Fats 5  per  cent  lost,  95  per  cent  absorbed 

Protein 8  per  cent  lost,  92  per  cent  absorbed 

When  allowance  is  made  for  tlie  above  losses,  biological  chemists  have 
approximated  the  physiological  fuel  value  of  food  constituents  consumed 
to  be  as  follows : 

Carbohydrates  .  .  (4.1     X  98  per  cent)  yield  4.  calories  per  gram 

F'ats (9.45  X  95  per  cent)  yield  9.  calories  per  gram 

Protein    (4.35  X  92  per  cent)  yield  4.  calories  per  gram 


FOOD  AS  A  SOUKCE  OF  IIFAT  A^\l)  GliOWTH        251 

Knbner's  calculation  shows  the  energy  values  of  foodstulis  to  be  as 
follows : 

Carbohydrates  yield  4.1  calories  per  gram 

Fats  ./. "       D.8        "  "       " 

Protein    "       4.1        "  "       " 

Jvubner's  estimate  was  derived  from  experiments  with  dogs  fed  on 
meat,  starch,  sugar,  etc.,  and  made  no  calculation  for  the  loss  in  diges- 
tion as  has  been  found  by  other  competent  observers  to  occur  with  men 
living  on  an  ordinary  well-balanced  ration. 

Food  ingested  represents  potential  chemical  energy  which  is  the  source 
of  all  bodily  energy.  In  order  to  arrive  at  a  correct  determination  of  the 
potential  energy  in  food  consumed,  it  is  necessary  to  know  how  much  food 
is  consumed  and  the  potential  energy  of  the  various  foodstuffs.  By  refer- 
ring to  page  258  will  be  found  a  table  which  graphically  expresses  the 
caloric  vahie  of  different  foods  involved  in  the  process  of  nutrition.  The 
reader  is  also  requested  to  consult  The  Analysis  and  Fuel  Value  of  Foods, 
Volume  I,  Chapter  XIX,  which  contains  a  list  of  all  known  American 
foods  and  graphically  presents  the  analysis  of  foods,  showing  the  percent- 
age of  protein,  fat,  carbohydrate  and  mineral  salts  with  the  caloric  value 
per  pound  and  per  portion. 

Constructive  and  Fuel  Foods. — We  have  previously  pointed  out  in  this 
chapter,  the  methods  for  calculating  the  fuel  value  or  potential  energy  of 
foods.  It  has  been  determined  by  means  of  calorimetric  experiments  that 
the  amount  of  heat  given  off  from  a  known  weight-  of  food  substance  is 
fairly  constant  and  is  called  the  heat  value,  or  heat  of  combustion,  which 
is  expressed  in  calories.  The  consideration  of  a  large  number  of  estima- 
tions of  the  heat  value  produced  in  the  calorimeter  and  of  the  digestibility 
of  foods  led  Rubner(6)  to  fix  their  value  approximately,  as  graphically 
pointed  out  in  table  on  this  page.  These  figures  are  accepted  by  the  ma- 
jority of  observers  as  being  approximately  correct,  and  so  have  passed  into 
common  use.  The  experiments  of  Rubner,  Atwater  and  other  investiga- 
tors seem  to  show  that  the  various  foods  may  replace  each  other  in  exact 
ratio  to  energy  derived  from  them  which  we  have  already  discussed 
(Volume  II,  Chapter  V,  Various  Factors  Bearing  on  Diet,  Digestion 
and  Assimilation).  Thus  100  gi'ams  of  fat  are  isodynamic  with  225 
of  syntonin,  243  grams  of  dried  muscle,  232  grams  of  starch,  234  grams 
of  cano  sugar  and  250  grams  of  dextrose.  In  otlier  words,  227  gi*ams  of 
carbohydrates  or  protein  arc  ecpial  in  isodynamic  value  with  100  grams 
of  fat,  because  they  yield  930  calories  on  combustion  in  the  body. 


252  THE    CALORIC    METHOD    OF    FEEDING 

As  shown  in  a  previous  chapter  (Volume  II,  Chapter  VII),  a  certain 
amount  of  protein  is  necessary  to  sustain  life.  It  is  not  sufficient  to  say 
that  a  food  to  be  able  to  maintain  life  and  strength  can  furnish  a  given 
number  of  calories,  since  any  number  of  calories  can  be  obtained  from 
fat,  but  fat  will  not  maintain  life  nor  promote  growth  of  cells.  Alimenta- 
tion must  be  estimated  in  terms  of  protein  required  and  of  calories 
required.  A  large  proportion  of  the  latter  can  be  obtained  from  variable 
amounts  of  fats  and  carbohydrates,  but  such  an  alimentation  would  not 
build  the  body,  though  it  would  furnish  the  necessary  fuel  for  body 
activities. 

Let  us  emphasize  at  this  point  the  two  clearly  differentiated  needs  of 
the  body:  (a)  for  constructive  material,  and  (&)  material  for  fuel.  The 
constructive  foods  are :  proteins,  salts  and  water.  The  fuel  foods  are : 
sugar,  starch  and  fat.  Xote  that  the  fuels  are  composed  of  carbon,  hydro- 
gen and  oxygen.  They  are,  chemically,  the  carbonaceous  foods,  which 
oxidize  to  CO2  and  IIoO.  The  value  of  these  fuel  foods  to  the  body  is 
based  wholly  upon  their  fuel  value,  which  is  measured  by  the  number  of 
calories  of  heat  which  they  liberate  on  oxidation. 

On  the  other  hand,  the  value  of  the  constructive  foods  cannot  at  all 
be  measured  by  the  number  of  calories  which  they  represent.  Salts,  for 
example,  are  of  inestimable  value  for  body  building,  yet  they  have  no 
caloric  value — no  fuel  value.  Water  and  the  salts  are  just  as  truly  foods 
as  are  the  starches,  sugars  and  fats ;  but  they  are  constructive  foods  of  no 
fuel  value.  Similarly,  the  proteins  bring  C,  H,  'N,  S,  P  and  Fe,  to  the 
body  in  combinations  readily  digested,  absorbed  and  assimilated  into 
living  active  tissues.  These  elements  and  combinations  are  absolutely 
essential  to  growth  and  repair.  Their  constriictive  value — their  food 
value — is  very  great.  The  fuel  value  of  proteins  (5.65  calories  per  gram) 
is  partly  available  eventually  for  fuel  purposes  when  taken  in  minim.al 
quantities,  and  immediately  available  to  the  extent  of  4  calories  per  gram 
when  taken  in  excess  of  the  requirements  for  construction.  This  avail- 
able fuel  value  is  its  fuel  value,  not  its  food  value.  Fuel  values  are  meas- 
ured in  calories  and  may  be  estimated  in  cents  per  calorie.  Constructive 
food  values  can  no  more  be  estimated  in  money  units  than  can  the  value 
of  a  living,  functioning  nerve  or  muscle  cell  be  estimated  in  dollars  and 
cents. 

Caloric  Requirement  of  Man — The  caloric  requirement  of  an  individual 
depends  somewhat  upon  his  weight  and  the  amount  of  energy  expended. 
As  a  result  of  much  research  and  investigation,  in  order  to  establish  a 
working  standard,  the  weight  fixed  upon  by  various  investigators  has  been 


EOOi)  AS  A  SOURCE  OF  HEAT  AND  GROWTH        253 

approximately  150  pounds.  The  caloric  requirement  for  a  man  of  this 
weight  leading-  a  sedentary  life  can  be  determined  by  the  following  four 
methods,  as  determined  by  Sherman (4): 

(a)  By  observing  the  amount  of  food  ingested  by  many  men  in  dif- 
ferent countries  and  under  varying  conditions. 

(h)   By  determining  the  approximate  amount  of  oxygen  consumed. 

(c)  By  determining  the  equilibriimi  or  balance  of  intake  and  output. 

(d)  By  direct  calculation  of  the  heat  given  off  by  the  body. 

These  various  methods  give  approximately  the  same  findings:  a  man 
at  rest  requires  2,000  calories,  and  one  leading  a  sedentary  life  requires 
2,300  calories. 

The  protein  requirement  for  a  man  at  work  cannot  be  determined  so 
accurately.  It  has  been  attempted  by  various  observers  with  the  following 
results : 

Voit  in  Germany  fixed  upon  118  grams  of  protein  as  the  standard. 
Playfair  in  England  fixed  upon   119  grams  of  protein  as  the 

standard. 
Gautier  in  France  fixed  107  grams  as  the  standard. 
Atwater  in  this  coimtry  fixed  100  grams  of  protein  as  the  standard 

for  a  man  of  sedentary  habits. 
Atwater  also  fixed  125  grams  for  a  man  at  moderate  work,  150 
grams  for  a  man  at  hard  work,  90  grams  for  one  completely 
at  rest. 
Chittenden  decided  upon  60  grams  as  the  standard.    His  objection  to 
the  high  protein  ration,  given  by  other  workers  in  this  field  of  research, 
is  based,  he  says,  upon  evidence  of  self-indulgence  and  not  upon  the  needs 
of  an  individual  or  upon  the  most  profitable  use  of  food.     We  give  below 
the   results   of  his   experiments.      For  a   man   of  average  weight    (154 
pounds),  it  is  necessary  to  provide  for  the  requisite  quantity  of  food,  (10 
grams  of  protein  and  a  total  caloric  value  of  2,800  calories.     The  follow- 
ing is  a  sample  dietary  suggested  by  Chittenden (7),  showing  the  protein 
in  gTams  and  the  caloric  value  of  each  article: 

THE  CHITTENDEN  LOW  PROTEIN  DIETARY 

BreaJcfaat:                                                                     Protein,  grams  Calories 

1  shredded  wheat  biscuit  (30  gm.) 3.15  106 

1  teacup  of  cream  (120  gm.) 3.12  206 

1  German  water  roll  (57  gm.) 5.07  165 

2  one-inch  cubes  of  butter  (38  gm.) 0.38  284 

H  cup  of  coffee  (100  gm.)  with 0.26 

}4  cup  of  cream  (30  gm.) 0.78  51 

1  lump  of  sugar  (10  gm.) 38 

' 12,76  —      850 


254  THE    CALORIC    METHOD    OF    FEEDING 

THE    CHITTENDEN   LOW   PROTEIN    DIETARY— Continued 

Lunch:                                                                             Protein,  grams  Calories 

1  teacup  home-made  chicken  soup  (144  gm.) 5.25  60 

1  Parker  House  roll  (38  gm.) 3.38  110 

2  one-inch  cubes  of  butter  (39  gm.) 0.38  284 

1  slice  lean  bacon  (10  gm.) 2.14  65 

1  small  baked  potato  (2  oz.-60  gm.) 1.53  55 

1  rice  croquette  (90  gm.) 3.42  150 

2  ounces  maple  sirup  (60  gm.) 166 

1  cup  tea  with  1  slice  lemon 

1  lump  sugar  (10  gm.) 38 

16.10         928 

Dinner: 

1  teacup  cream  of  corn  soup  (130  gra.) 3.25  72 

1  Parker  House  roll  (38  gm.) 3.38  110 

1  one-inch  cube  of  butter  (19  gm.) 0.19  142 

1  small  lamb  chop  broiled,  lean  meat  (30  gm.)..  .  .    8.51  92 

1  teacup  of  mashed  potato  (167  gm.) 3.34  175 

Apple-celery  lettuce  salad  with  mayonnaise  dress- 
ing (50  gm.) 0.62  75 

1  Boston  cracker  split,  2  in.  in  diameter  (12  gm.).   1.32  47 

3^inch  cube  American  cheese  (12  gm.) 3.35  50 

}/2  teacup  of  bread  pudding  (85  gm.) 5.25  150 

1  demi-tasse  coffee 

1  lump  sugar  (10  gm.) 38 

29.21  951 

Total  grams  of  protein 58.07 

Total  calories 2729 

The  total  amount  of  protein  in  grams  and  the  total  calories  in  this 
dietary,  as  stated  above,  may  be  taken  as  approximately  correct.  It  will 
be  seen  that  he  has  reduced  the  protein  to  as  low  a  point  as  is  compatible 
with  good  health,  mental  and  physical  streng-th,  but  has  allowed  sufficient 
carbonaceous  food  to  produce  the  requisite  calories  for  normal  energy. 
We  have  stated  heretofore,  and  will  reiterate  again,  that  more  protein  is 
ordinarily  consumed  than  is  needed  and  often  more  than  is  good  for  one. 

Calorific  Value  of  Excretory  Products. — All  non-nitrogenous  foodstuffs 
which  have  undergone  complete  digestion  and  assimilation  yield  in  our 
bodies  the  same  amount  of  heat  as  in  the  calorimeter,  the  final  products 
being  the  same.  The  nitrogenous  foodstuffs  are  not  so  completely  metab- 
olized; the  oxidation  of  proteins  in  the  body  is  not  complete.  We 
learned,  when  studying  the  Physiology  of  Digestion,  that  the  protein 
molecule  is  made  up  of  some  twenty  or  more  amino-acids.  We  also  found 
that  the  protein  molecule  is  split  into  a  nitrogen-moiety  and  a  carbon- 
moiety(8).  The  carbon-moiety  is  as  completely  oxidized  in  the  body  as 
in  the  calorimeter  experiments.  The  nitrogen-moiety  is  not  reduced  in 
the  animal  body  to  ammonia  and  water — the  ultimate  products  of  nitro- 
genous decomposition — but  it  is  excreted  as  an  organic  compound,  which 


FOOD  AS  A  SOURCE  OF  HEAT  ANT)  GROWTH        255 

iu  mau  is  cliieMy  urea,  and  a  smaller  proportion  of  quaternary  substances 
(usually  referred  to  as  "meat  bases")  which  have  a  calorie  value  but  no 
food  value.  In  order  to  arrive  at  the  definite  calorific  value  of  the  excre- 
tory products,  they  must  be  subtracted  from  the  fuel  value  of  nitrogenous 
foodstuffs  as  ascertained  by  calorimetric  experimentation.  The  balance 
represents  only  the  actual  energy  yielded  to  the  body  and  is  known  as  the 
"physiological  heat"  value.  It  may  be  noted  in  passing  that  the  unavail- 
able energy  of  the  proteins  is  that  represented  by  the  urea,  urates,  nitrates, 
sulphates  and  other  more  or  less  complex  substances  excreted  in  the  urine 
which  are  subject  to  further  combustion,  so  that  the  animal  body  is  able 
to  extract  from  proteins  only  about  four  calories,  while  the  calorimeter 
experiments  in  complete  combustion  is  able  to  extract  5.65  calories. 

It  may  be  safely  stated  as  a  general  working  rule,  that  each  gTam  of 
protein  consumed  results  in  the  excretion  of  about  one-third  of  a  gram 
of  urea. 

The  factors  of  Rubner,  as  previously  mentioned,  are  generally  agreed 
upon  as  being  approximately  correct,  but,  in  order  to  ascertain  the  physio- 
logical available  energy,  the  food  should  be  burnt  in  a  bomb  calorimeter 
already  described,  and  the  figure  obtained  will  be  the  gross  heat  value. 
From  this,  as  we  have  previously  mentioned,  must  be  subtracted  the  heat 
yielded  by  the  urine  and  feces  by  combustion,  and  the  net  will  show  the 
physiological  availability  of  the  energy.  In  his  physiological  researches, 
Rubner (6)  made  many  such  experiments,  and  the  following  is  summed 
up  from  his  results,  to  which  Tibbles(9)  refers: 

RUBNER'S    TABLE   SHOWING   LOSSES   AND   AVAILABLE   ENERGY 


Food 

Heat  Lost,  Per  Cent 

Availability 

of  Energy, 

Per  cent 

In  Urine 

In  Feces 

Total 

Mixed  diet:  Poor  in  fat.  .  . . 

Rich  in  fat ... . 

Meat  diet     

4.70 
3.87 
16.30 
5.13 
2.40 
2.20 
2.00 

6.00 
5.73 
6.90 
5.07 
15.50 
24.30 
5.60 

10.70 
9.60 
23.20 
10.20 
17.90 
26.50 
7.60 

89.3 
90.4 
76  4 

Cow's  niilk 

89  4 

Graham  broad 

82  1 

Rye  broad 

73.5 

Potatoes 

92.4 

Physiological  Food  Value — The  value  of  a  fuel  food  to  the  body  is 
finally  measured  by  the  number  of  calories  which  it  can  yield  when 
oxidized  in  the  tissues — the  physiological  food  value.  But  this  value 
depends  upon  digestibility  and  absorbability.    It  was  formerly  considered 


256  THE    CALOEIC    METHOD    OF   FEEDING 

that  the  measure  of  digestibility  of  any  foodstuff  depended  upon  the 
length  of  time  it  remained  in  the  stomach  and  freedom  from  discomfort 
during  the  process  of  digestion.  In  normal  individuals  the  process  of 
digestion  is  unaccompanied  by  any  feelings  save  that  of  satisfaction  and 
well  being.  It  is  only  under  abnormal  conditions  that  the  presence  of 
food  in  the  stomach  or  alimentary  canal  gives  rise  to  any  other  sensation. 
Beaumont (10),  in  a  long  series  of  experiments  on  Alexis  St.  Martin,  who 
suffered  from  a  gastric  fistula,  was  able  to  determine  exactly  the  length 
of  time  the  food  remained  in  the  stomach.  For  many  years  his  experi- 
ments were  accepted  as  authoritative,  but  the  science  of  nutrition  has 
shown  many  errors  in  his  reasoning  and  conclusions. 

Physiologists  in  recent  years  have  conducted  experiments  with  the 
object  of  ascertaining  the  period  of  time  various  foods  remain  in  the 
stomach (11).  Penzoldt,  in  working  out  this  question,  made  observations 
on  the  gastric  digestion  in  healthy  men.^  He  allowed  his  subjects  to  have 
a  stated  amount  of  certain  foodstuffs,  the  exact  amount  and  consistence  of 
which  he  took  careful  note.  He  allowed  this  to  remain  in  the  stomach 
for  a  definite  time  and  removed  the  contents  with  a  stomach  tube,  and  he 
found  that  the  time  it  remained  in  the  stomach  had  a  marked  influence 
upon  it.  Physiologists  have  definitely  determined  the  fact  that  fluids  pass 
out  of  the  stomach  more  rapidly  thaii  solids.  For  instance,  six  to  eight 
ounces  of  water  or  beverages  pass  out  of  the  stomach  during  the  course 
of  30  minutes.  It  was  found  that  hot  drinks  did  not  pass  out  of  the 
stomach  any  quicker  than  cold  ones.  Solid  food  substances  in  solution 
or  suspension  were  somewhat  delayed  in  leaving  the  stomach,  thus  it  took 
two  hours  for  eight  ounces  of  milk  to  pass  through  the  stomach.  It  is 
a  well-known  fact  that  the  length  of  time  food  remains  in  the  stomach  is 
not  a  definite  criterion  of  the  ease  or  difficulty  of  its  digestion.  On  the 
other  hand,  it  would  be  an  error  to  consider  as  "indigestible"  those  foods 
which  remain  in  the  stomach  a  longer  time  than  others  or  to  suggest  that 
they  should  be  avoided  by  healthy  people. 

According  to  Tibbies (8)  : 

The  test  of  time  occupied  by  its  passage  through  the  stomach  refers  only  to 
the  "apparent  digestibility,"  while  the  test  of  "actual  digestibility"  is  the  amount 
absorbed.  It  has  been  truly  said  that  "We  live  not  upon  what  we  eat,  but  upon 
what  we  digest."  The  term  "digestibility,"  therefore,  refers  to  the  entire  process 
of  digestion,  and  not  merely  to  that  which  occurs  in  the  stomach.  In  this  sense 
a  "digestible  food'  is  one  of  which  the  largest  possible  percentage  is  absorbed, 
and  an  "indigestible  food"  is  one  of  which  a  considerable  portion  passes  out  of 
the  system  in  the  feces  without  being  disintegrated  and  absorbed. 
1  See  Volume  III,  Chapter  I,  for  Penzoldt's  observations. 


CALCULATION   OF   LULL   VALUEiS   OF   FOOD 


257 


CALCULATION  OF  FUEL  VALUES  OF  FOOD 

Chemical  Analyses  of  Foods — To  calculate  the  fuel  values  of  food  it  is 
necessary  to  have  before  one  tables  showing  the  chemical  analysis  of  the 
food  in  question.  Taking  from  the  tables  the  component  parts  of  the 
aliment  to  be  used,  and  multiplying  by  the  factors  representing  the  num- 
ber of  calories  per  gram  of  carbohydrates,  fats  or  proteins  as  the  case 
may  be,  one  can  quickly  determine  the  calories  per  100  gram  or  the 
calories  per  pound  in  any  given  article  of  food.  For  assistance  on  this 
point  the  reader  is  referred  to  an  abbreviated  table  given  on  the  following 
page,  containing  the  estimate  of  protein,  fats,  carbohydrates  and  caloric 
value  for  portions  ordinarily  served.  For  a  more  extensive  table,  see 
Volume  I,  Chapter  XIX,  where  an  accurate  analysis  of  protein,  fats, 
carbohydrates,  mineral  matter  and  caloric  value  per  pound  and  per  por- 
tion is  given  for  the  different  American  foods.  A  study  of  these  tables 
will  afford  a  basis  for  calculating  the  requisite  number  of  calories  con- 
tained in  different  foods  for  a  well-balanced  ration. 

From  the  following  table  compiled  from  the  more  extensive  work  by 
Locke  (12)  it  will  be  easy  to  estimate  the  percentage  of  ternary  food  ele- 
ments contained  in  the  common  foodstuffs,  together  with  the  caloric  value 
given  for  individual  portions  ordinarily  served : 

COMPARATIVE  EQUIVALENTS  IN  METRIC,  AVOIRDUPOIS  AND 
APOTHECARIES'  WEIGHTS  AND  MEASURES' 


Weights 

Metric 
Weights 

AND 

Measures 

Measures 

Grains 

Apothecaries' 
oz.            gr. 

Avoirdupois 
lb.    oz.       gm. 

gm.  or  c.c. 

Fluid 
oz.       minims 

Fluid 

ounces  and 

fractions 

15432.4 
7000.0 
1543.2 
480.0 
456.392 
437.5 
15.4324 
1 
0.9508 

32             72.4 
14          280.0 

3           103.2 

1 

2      3    119.9 
1      

3   230.7 
.       1     42.5 
.       1      18.89 

1       .... 

1000 
453.592 
100 

31.1035 
29.5737 
28.350 
1 

0.06479 
0.06161 

33    390.06 

15     162.1 

3     183.1 

1       24.8 

1         

. .     460.1308 
. .       16.23 
1.0517 
1 

33.814 

15.338 

3.382 

1.052 

1 

0.959 
0.0338 
0.0022 
0.0021 

1  From  the  United  States  Pharmacopeia. 


258  THE    CALORIC    METHOD    OF    FEEDING 

VALUES  OF  THE  ORDINARY  FOODS  PREPARED  TO  SERVE 


Foodstuffs 


Quantity 


Weight 

Protein 

Fats 

Car- 

(Gms.) 

(Gms.) 

(Gms.) 

bohy- 
drates 

120 

5.88 

0.72 

100 

6.00 

1.90 

9.40 

100 

22.30 

28.60 

100 

23.50 

20.40 

80 

32.00 

0.45 

125 

16.26 

12.62 

21.76 

100 

32.10 

4.40 

2.10 

100 

21.70 

29.90 

75 

14.78 

9.53 

75 

23.18 

3.38 

100 

22.60 

4.50 

75 

18.75 

16.95 

33 

7.29 

6.80 

35 

7.77 

11.62 

35 

4.55 

15.47 

0.39 

100 

27.80 

18.40 

80 

22.82 

1.14 

75 

21.33 

1.00 

100 

25.90 

4.50 

100 

21.68 

0.27 

1.58 

100 

20.35 

4M 

70 

11.73 

4.48 

2.62 

100 

19.65 

10.21 

5.36 

10 

2.30 

1.97 

50 

10.57 

1.17 

.62 

150 

12.90 

1.5 

3.00 

100 

6.50 

0.4 

4.20 

245 

19.36 

2.21 

1.47 

105 

17.22 

1.89 

.42 

85 

5.27 

1.02 

3.15 

124 

6.07 

11.06 

10.53 

138 

8.06 

18.58 

11.98 

110 

28.20 

1.75 

6.02 

120 

3.84 

1.68 

11.28 

120 

12.60 

0.96 

2.88 

120 

4.56 

1.08 

5.64 

120 

2.16 

.96 

8.04 

120 

3.00 

0.48 

125 

3.44 

8.62 

■  4.87 

125 

3.00 

8.94 

5.01 

125 

3.75 

8.70 

10.66 

125 

6.29 

8.46 

14.07 

125 

2.99 

9.40 

6.36 

120 

6.24 

1.08 

3.36 

120 

4.80 

1.56 

5.16 

Total 
Calories 


Beef  juice 

Corned  beef  hash 

Roast  beef 

Steak,  tenderloin  beef. 

Sweetbreads 

Creamed  chicken  on  toast 

Roast  chicken 

Lamb  chop  with  bone 

Roast  lamb 

Boiled  mutton,  lean . . 

Mutton  chop,  lean. . . . 

Mutton,  roast  leg 

Ham,  smoked,  boiled,  as 
purchased 

Ham,  smoked,  fried. . , 

Sausage,  uncooked 

Roast  turkey 

Veal  cutlet 

Veal  roast 

Bluefish 

Codfish 

Halibut 

Mackerel 

Salmon 

Sardines,  canned 

Trout,  brook 

Clams,  long 

Clams,  round 

Crabs,  hard  shelled,  as 
purchased 

Lobster 

Oysters 

Oyster  stew 

Scalloped  oysters 

Scallops,  fried 

Bean  soup,  home-made . 

Chicken     soup,     home- 
made  

Chicken    gumbo    soup 
canned 

Clam    chowder,    home- 
made  

Consomm^,  canned 

Asparagus,  cream  soup. 

Celery  cream  soup 

Corn  cream  soup 

Pea  cream  soup 

Tomato  cream  soup ... 

Mock  turtle,  canned. .  . 

Oxtail  soup,  canned 


4  ounces 

2  heap,  tblspoon. 

1  slice 

1  " 
2 

2  heap,  tblspoon. 
1  slice 

1  chop 
1  slice 
1     « 
1  chop 
1  slice 

1     « 

1     " 

1  sausage 

1  slice 

1  cutlet 

1  slice 

Average  helping 


1  fish 

Average  helping 
6  clams 
6     « 

1  crab 

6  oysters 

4  ounces 

6  large  oysters 

3  heap,  tblspoon. 

1  teacup 

1 


CALCULATION   OF  FUEL  VALUES   OF   FOOD         259 
VALUES  OF  THE  ORDINARY  FOODS   PREPARED  TO  SERYE— Continued 


Foodstuffs 


Vegetable  soup,  canned . 

Butter 

Average  cream 

Thick  cream 

American  cheese,  pale . . 

Camembert  cheese 

Fromage  de  brie 

Full  cream  cheese 

Neufchatel  cheese 

Roquefort  cheese 

Swiss  cheese 

Kumiss 

Buttermilk 

Whole  milk 

Whey 

Hen's  eggs,  boiled 

Omelette,  egg 

Ingredients:  3  tblspoon . 

milk,  3  eggs,  1  heap. 

teaspoon  butter. . .  . 

Asparagus,  canned 

Baked  beans,  home-made 

Butter  beans 

Lima  beans 

String  beans 

Beets 

Cabbage 

Carrots 

Cauliflower 

Celery,  uncooked 

Corn,  canned 

Corn,  green 

Cucumber,  uncooked .  . . 
Mushrooms,  broiled .... 

Onions 

Peas,  green 

Potatoes,  sweet,  boiled . . 

Baked  potatoes 

Boiled  potatoes 

Mashed    and    creamed 

potatoes 

Squash 

Spinach 

Tomatoes,  canned. . . . 
Tomatoes,  uncooked.. 

Turnips 

Apple 

Banana 

Blackberries 

Cantaloupe 


Quantity 


1  teacup 

Iball 

1  tblspoon, 

1 

1  cubic  inch 

1  heap,  tblspoon, 

1  cubic  inch 

1  u  u 

1  «  « 

1  «  « 

1  slice 

1  wineglass 

1  glass 

1     « 

1     « 

1  egg 

}/2  omelette 


3  heap,  tblspoon. 

4  «  «( 

2     «  « 

2     «  « 

2  «  « 

3  "  « 
3     «  « 

2  "  " 

3  small  stalks 

2  heap,  tblspoon. 

1  ear 

8  thin  slices 

2  large,  on  toast 
1 

3  heap,  tblspoon. 
Average  size 
Medium   " 


2  heap,  tblspoon. 

2     "  " 

2     «  « 

2     "  " 

Medium  size 

2  heap,  tblspoon. 
Average  size 

«  u 

3  heap,  tblspoon. 
^  melon 


Weight 

Protein 

Fats 

(Cms.) 

(Gms.) 

(Gms.) 

120 

3.48 

15 

0.15 

12.75 

20 

0.74 

5.14 

20 

0.31 

11.22 

20 

5.70 

7.18 

20 

4.20 

4.34 

20 

3.18 

4.20 

20 

5.18 

6.74 

20 

3.74 

5.48 

20 

4.52 

5.90 

20 

5.52 

6,98 

130 

3.64 

2.73 

218 

6.54 

1.09 

220 

7.26 

8.80 

203 

2.03 

0.61 

50 

6.60 

6,00 

75 

9.80 

14.01 

125 

1.88 

0.13 

150 

10.83 

12.76 

180 

63.78 

0.24 

80 

6,40 

0.54 

60 

0.48 

0.66 

70 

1.61 

0.07 

100 

0.60 

0.10 

100 

0.53 

0.17 

120 

1.08 

0.12 

55 

0.50 

0.05 

100 

2.80 

1.20 

100 

3.07 

1.10 

50 

0.40 

0.10 

57 

3.52 

8.94 

100 

1.20 

1.80 

92 

6.16 

3.13 

100 

3.00 

2.10 

130 

3.77 

0.20 

150 

3.75 

0,15 

100 

2.60 

3.00 

100 

1.36 

0.82 

100 

2.10 

4.10 

70 

0.84 

0.14 

200 

2.40 

0.40 

140 

0.45 

0.08 

150 

0.45 

0.45 

194 

1.55 

0,78 

100 

1.30 

1.00 

465 

1.40 

Car- 
bohy- 
drates 


Total 
Calories 


0.6 

0.71 

.46 

0.06 

0.28 

0.48 

.30 

0.36 

0.26 

7.02 

10.46 

11.00 

10.15 

1.55 


3.50 

32.84 

11.60 

23,60 

1.14 

5.18 

0.40 

3.39 

0.48 

1.43 

19.00 

18.78 

1.55 

12.85 

4.90 

13.43 

42.1 

32.07 

31.35 

17.80 

13.60 

2.60 

2.80 

8.00 

0.91 

16.22 

27.74 

10.90 

21.39 


17 

119 
54 

108 
91 
58 
53 
86 
68 
75 
89 
69 
80 

157 
56 
83 

177 


23 

298 

65 

128 

13 

29 

5 

18 

8 

8 

101 

100 

9 

150 

42 

110 

204 

149 

145 

112 
69 
57 
16 
46 
6 
72 

127 
59 
93 


260  THE    CALOKIC   METHOD    OF    rEEDi:N'G 

VALUES  OF  THE  ORDINARY  FOODS  PREPARED  TO  SERVFr-Contlnued 


Foodstuffs 


Quantity 


Weight 

Protein 

Fats 

Car- 

(Gms.) 

(Gms.) 

(Gms.) 

bohy- 
drates 

100 

0.90 

0.80 

15.90 

100 

1.50 

12.80 

300 

2.37 

0.60 

30.27 

150 

1.50 

1.80 

21.60 

90 

0.90 

11.79 

100 

0.60 

0.60 

16.60 

130 

.91 

.65 

7.67 

250 

1.50 

0.25 

21.25 

128 

0.64 

0.13 

9.86 

156 

0.78 

0.62 

19.81 

100 

0.40 

0.30 

9.70 

35 

0.32 

6.69 

82 

0.82 

10.33 

100 

1.00 

0.60 

7.40 

300 

.60 

0.30 

8.10 

80 

3.76 

0.80 

50.00 

83 

1.58 

2.08 

58.60 

117 

8.38 

0.58 

59.28 

200 

3.60 

124.40 

25 

0.57 

0.75 

17.13 

120 

0.61 

0.58 

29.30 

125 

0.25 

1.00 

46.50 

100 

0.27 

0.41 

36.00 

35 

0.36 

27.16 

30 

0.18 

0.03 

25.35 

90 

0.40 

0.47 

32.40 

39 

3.51 

.23 

20.74 

37 

3.29 

0.67 

19.28 

35 

3.05 

0.91 

19.36 

38 

3.53 

5.21 

19.99 

39 

3.32 

0.98 

21.72 

42 

4.07 

0.38 

20.87 

15 

1.47 

1.49 

11.03 

10 

1.10 

0.85 

7.11 

8 

0.80 

0.75 

5.9 

11 

1.24 

1.16 

7.76 

6 

0.58 

0.23 

4.37 

3 

0.97 

1.39 

6 

0.59 

0.55 

4.38 

70 

8.61 

3.78 

22.47 

100 

9.60 

12.70 

34.50 

70 

7.28 

10.07 

26.55 

136 

9.03 

14.60 

37.15 

65 

7.78 

0.40 

51.51 

115 

3.85 

4.11 

9.52 

Total 
Calories 


Cherries 

Currants 

Grapefruit 

Grapes 

Gooseberries 

Huckleberries 

Lemon 

Orange 

Peach 

Pear 

Pineapple,  edible  portion 

Plum... 

Raspberries 

Strawberries 

Watermelon 

Apricots,  dried 

Dates 

Figs 

Prunes 

Raisins 

Apple,  baked 

Apple,  sauce 

Cranberries,  stewed 

Currant  jelly 

Marmalade,  orange 

Rhubarb,  stewed 

Rye  bread 

Graham  bread 

Biscuits,  home-made. . .  . 

Biscuits,  soda 

Rolls,  French 

Whole  wheat 

Zwieback 

Boston  cracker  (split) . . 

Graham  cracker 

Oyster  cracker 

Pretzels 

Educators,  soda  cracker . 

Uneeda  biscuits 

Chicken  sandwiches .... 

Egg  sandwich 

Ham  sandwich 

Cream  toast 

Ingredients:  2  slices 
toast;  5  tblspoon. 
cream  sauce. 

Grapenuts 

Cornmeal  mush 

Ingredients:  2  table- 
spoons  white    corn 

meal;  2  cups  milk 


About  3^  pound 

4  heap,  tblspoon. 

H  large 

1  bunch 

4  heap,  tblspoon. 

4      «  « 

Average  size 


2  slices 
Average  size 

3  heap,  tblspoon. 

4  «  « 

Large  slice 

10  large 

10     " 

10     " 

10  very  large 

10     " 

1  large 

3  heap,  tblspoon. 

2  "  " 

1  «  u 

1  u  u 

2  «  " 
1  slice 

1    « 

1  biscuit 

1       « 

1  roll 

1  sUce 

1     « 

1  cracker 

1 

10  crackers 

1  pretzel 

1  cracker 

1 

1  sandwich 
1 

1 

2  slices 


5  heap,  tblspoon. 

4      «  « 


CALCULATION   OF   FUEL   VALUES   OF   FOOD         261 
VALUES  OF  THE  ORDINARY  FOODS   PREPARED  TO  SERVE— Continued 


Weight 

Protein 

Fats 

Car- 

Total 

Foodstuffs 

Quantity 

(Gms.) 

(Gms.) 

(Gms.) 

bohy- 
drates 

Calories 

Hominy,  boiled 

2  heap,  tblspoon. 

100 

2.20 

0.20 

17.80 

84 

Indian  meal  mush 

3      "           " 

115 

2.10 

1.18 

18.50 

96 

Macaroni,  boiled 

2     «           « 

100 

3.00 

1.50 

15.80 

91 

Macaroni,    baked    with 

chee.se 

2     « 

2     «           " 

140 
100 

19.06 
2.80 

20.46 
0.50 

43.44 
11. .50 

447 

Oatmeal,  boiled 

63 

Puffed  rice 

5      "     .       " 
1      «            « 

1  biscuit 

14 

100 

29 

0.87 
2.80 
3.05 

0.08 
0.10 
0.41 

12.00 
24.40 
22.59 

54 

Rice,  boiled 

112 

Shredded  wheat  biscuit . 

109 

Spaghetti,    baked    with 

tomato 

3  heap,  tblspoon. 

J^pie 

%    " 

145 

4.52 

2.81 

25.76 

150 

Annie  oie 

126 

3.91 

12.35 

53.93 

352 

r'r'*^  f^^'^ 

Custard  pie 

133 
110 
113 
133 

5.59 
3.96 
6.55 
5.85 

8.38 
11.11 
13.90 
11.17 

34.71 
41.14 
43.05 

28.86 

243 

Lemon  pie 

288 

Mince  pie 

333 

Squash  pie 

246 

Bread  pudding 

2  heap,  tblspoon. 

105 

5.52 

4.79 

38.48 

225 

Ingredients:     1     cup 

bread  crumbs;  1  cup 

milk;  1  egg;  i^  cup 

sugar;  }4  cup  raisins 

Baked  custard 

2     «           « 

134 

7.31 

7.42 

20.50 

183 

Ingredients :    2    cups 

milk;    2   eggs;    }4 

sugar. 

Soft  custard 

4  tblspoon. 

GO 

4.39 

6.84 

12.12 

131 

Ingredients:  Yolk  1  egg; 

3^  cup  milk ;  1  heap. 

tblspoon.  sugar. 

Snow  pudding 

2  heap,  tblspoon. 

80 

4.52 

0.03 

11.73 

67 

Ingredients:    ^     cup 

water;  1  heap,  tea- 

spoon gelatin;  2  h. 

tblspoon.    sugar;    1 

teaspoon  lemon  j  nice 

lemon  rind;  white  1 

egg. 

Tapioca  pudding 

3     «           « 

110 

5.85 

6.12 

22.25 

172 

Ingredients:  2    cups 

milk;  1  egg,  3  table- 

spoons   tapioca;    2 

tablespoons  sugar. 

Tapioca  and  apples..  . . . 

2      "            « 

100 

0.21 

0.22 

28.58 

120 

Ingredients:    9    small 

apples;  1  cup  sugar: 

%  cup  tapioca;    2 

cups  water. 

117 


262  THE    CALORIC    METHOD    OF    FEEDING 

VALUES  OF  THE  ORDINARY   FOODS   PREPARED  TO  SERVE— ^o/i^mwerf 


Foodstuffs 


Quantity 


Weight 
(Gms.) 

Protein 
(Gms.) 

90 

4.76 

37 
50 

2.48 
5.22 

100 

5.21 

20 

10 

100 

1.76 
0.65 
0.94 

85 

3.31 

11 

21 

0.2 

30 
7 
6 

10 

12 
100 

15 

.12 
3.15 

Fats 
(Gms.) 


Car- 
bohy- 
drates 


Total 
Calories 


Blancmange 

Ingredients:  1  heap 
tblspoon.  c  o  r  n  - 
starch;  1  heap 
tblspoon.  sugar;  ] 
egg;  1  cup  milk;  1 
tblspoon.  sherry 

Doughnuts 

Egg  souffle 

Ingredients:  2  eggs;  3^ 
cup  sugar;  1  table- 
spoon  lemon    juice 

Ice  cream 

Ingredients:  3  cups 
milk;  1  cup  cream;  3 
eggs;  %  cup  sugar; 
vanilla 

Ladyfingers 

Macaroons 

Orange  ice 

Ingredients:  2}/^  cups 
orange  juice;  J^cup 
lemon  juice;  \^ 
cups  sugar;  1  cup 
water;  rind  2 
oranges 

Prune  souffle 


Ingredients:  )/^  cup 
stewed  prunes  (edi- 
ble portion),  white 
i  egg. 

French  dressing 

Ingredients: 'iihlspoon. 
olive  oil;  1  tblspoon. 
vinegar;  3<C  teaspoon 
salt;  pepper. 

Mayonnaise  dressing 

Ingredients:  2  eggs;  2 
cups  olive  oil;  1 
tblspoon.  vinegar, 
or  1  tblspoon.  lemon 
juice;  salt,  pepper, 
mustard. 

Honey 

Cube  sugar 

Domino  sugar 

Granulated  sugar 

Powdered  sugar 

Maple  sugar 

Almonds 


2  heap,  tblspoon. 


4.91 


16.83 


1  doughnut 
H  souffl6 


2  heap,  tblspoon. 


1 
1 
2  heap,  tblspoon. 


2     « 


1  dessert  spoon 


1  tblspoon. 


1 

1  cube 

1  domino 

1  heap,  teaspoon 

1  u  u 

1  cake 
10  large 


7.77 
4.09 


10.16 


1.00 
1.52 
0.23 


0.65 


8.00 


19.92 


8.23 


19.65 
38.09 


17.73 


14.12 

6.52 

74.68 


18.95 


0.05 


24.36 

7.00 

6.00 

10.00 

12.00 

82.80 

2.60 


CAJX'ULA'JION   OF   FUEL  VALUES   OF   FOOD         263 
VALUES  OF  THE  ORDINARY  FOODS  PREPARED  TO  SERVE— Continued 


Foodstuffs 


Quantity 


Weight 

Protein 

Fats 

Car- 

(Cms.) 

(Gms.) 

(Gms.) 

bohy- 
drates 

60 

10,20 

40.08 

4.20 

50 

2.60 

2.25 

17.70 

34 

1.94 

17.20 

9.49 

10 

1.56 

6.53 

1.30 

30 

5.85 

8.73 

5.55 

30 

3.30 

21.36 

3.99 

42 

7.73 

27.05 

5.46 

227 

9.08 

15.53 

23.85 

246 

2.80 

7.64 

17.83 

270 

13.00 

12.85 

29.50 

Total 
Calories 


Brazil  nuts 

Chestnuts,  roasted,  as 
purchased 

Cocoanut 

Filberts 

Peanuts,  as  purchased . . 

Pecans 

Walnuts 

Cocoa 

Ingredients:  1  heap,  tea- 
spoon cocoa;  1  heap, 
teaspoon  sugar;  ^ 
cup  milk ;  1  tblspoon. 
cream. 

Coffee  or  tea 

Ingredients  14  cup 
milk ;  1  tblspoon. 
cream ;  2  cubes 
sugar;  coffee  or  tea. 

Eggnog 

Ingredients:  1  egg;  1 
heap,  tblspoon. 
sugar;  ^  cup  milk; 
1  tblspoon.  sherry. 


10  large 

20  nuts 
1  shce 
10  nuts 
15     " 
10  large 
10     « 
1  cup 


1  glass 


432 

104 
207 
72 
128 
229 
306 
279 


156 


294 


In  discussing  the  energy  obtained  from  different  foods,  it  is  important 
to  distinguish  between  heat  produced  when  substances  are  burned  in  the 
calorimeter  and  the  heat  that  is  available  when  used  in  the  body,  since 
it  never  happens  that  the  combustible  portion  of  a  ration  is  entirely  con- 
sumed in  the  body.  The  total  food  is  never  all  digested,  therefore  it 
cannot  all  be  absorbed  and  assimilated.  Furthermore,  the  absorbed  and 
assimilated  proteins  are  never  fully  burned  and  there  is  usually  an  escape 
of  unconsumed  gases  from  the  alimentary  canal.  As  actual  work  is  per- 
formed in  the  process  of  digestion,  the  term  "net  energy"  has  been  intro- 
duced and  applied  to  the  amount  of  energy  which  is  available  after  that 
used  up  in  the  digestion  and  preparation  of  the  food  for  use  in  the  body 
has  been  subtracted. 

In  calculating  the  fuel  value  represented  by  a  particular  menu,  one 
deals  with  several  carbohydrates  in  various  proportions;  similarly  with 
fats  and  proteins  derived  from  both  animal  and  vegetable  foods.  Instead 
of  computing  the  ditlVreut  foodstuffs  separately,  it  will  be  found  more 
convenient  to  use  the  average  value  given  in  the  table  on  page  248  and 


264  THE    CALORIC    METHOD    OF    FEEDING 

multiplying  the  total  amounts  of  carbohydrate  in  the  menu  by  this  factor. 
The  same  may  conveniently  be  done  with  the  fats  and  proteins.  The 
fuel  value  which  any  food  represents  is  easily  determined  by  using  the 
factors  in  this  table:  Ascertain  first  the  percentage  of  protein,  fat  and 
carbohydrate  which  the  menu  contains  and  multiply  these  several  amounts 
by  the  factors  given  in  this  table;  for  example,  oatmeal  contains  7.6  per 
cent  of  water,  15,5  per  cent  of  protein,  7.1  per  cent  of  fat,  68.2  per  cent 
of  carbohydrates  and  2  per  cent  of  salts.  One  hundred  grams  of  oatmeal 
represent  energy-,  viz. : 

From  protein   15.1  X  4.0  =    60.40 

From  fat 7.1  X  9.4  =    63.90 

From  carbohydrates 68.2  X  4.0  =  272.80 

Total    397.10 

The  total  fuel  value  of  one  pound  of  dry  oatmeal  is  obtained  by  multi- 
plying this  quantity  by  4.5.  The  heat  energy  or  fuel  value  of  almost 
every  known  food  is  given  in  the  table  on  page  702  (Analysis  and  Fuel 
Value  of  Foods,  Volume  I,  Chapter  XIX).  These  figures  are  suf- 
ficiently accurate  for  determining  the  caloric  value  of  dietaries  for  insti- 
tutional purposes  or  in  private  practice. 

Method  of  Reckoning  the  Protein,  Fat  and  Carbohydrate  Rations  for  Diets 
of  Definite  Energy  Values. — Voit's  dietary  standard  for  a  man  at  mod- 
erately hard  work  is  calculated  for  16  per  cent  of  the  energy  to  be  fur- 
nished by  protein,  18  per  cent  by  fat,  and  66  per  cent  by  carbohydrate. 
Where  the  total  fuel  value  of  the  ration  represents  3,000  calories, 
according  to  Coleman,  the  calculation  is  made  as  follows : 

16  per  cent  of  3,000  =    .  ^  =120  grams  protein 

540 

18  per  cent  of  3,000  =    q  .  =    57  grams  fat 

55  per  cent  of  3,000  =^~  a  n   '^  "^^^  grams  carbohydrate 

By  the  employment  of  Coleman's  method  the  rations  may  be  quite 
accurately  determined  for  diets  of  any  given  energy  value. 

With  the  above  facts  before  us  it  is  easy  to  determine  the  caloric  value 
contained  in  any  food,  provided  the  percentages  of  protein,  fat  and  carbo- 
hydrate are  known.    These  percentages  multiplied  by  the  figures  given  in 


FACTORS    GOVERNING    FOOD    REQUIRED  265 

the  table  previously  referred  to  and  their  results  added  will  give  the 
number  of  calories  in  100  grams  of  food.  It*  will  not  be  such  an  arduous 
task  to  calculate  the  caloric  value  of  a  meal  if  one  will  remember  the 
fuel  values  of  the  ordinary  portions,  viz. :  roast  beef,  357  calories ;  bread, 
100  calories;  butter,  150  calories;  rice  croquettes,  128  calories;  a  medium 
baked  potato,  150  calories;  tapioca  pudding,  120  calories;  sugar  and 
cream  with  coffee,  100  calories — which  will  total  1,105  calories  for  the 
meal,  or  about  one-third  of  the  day's  requirements. 

FACTORS  GOVERNING  THE  AMOUNT  OF  FOOD  REQUIRED 

The  amount  of  food  required  to  keep  any  person  in  a  normal  state  of 
health  and  bodily  equilibrium  differs  according  to  various  circumstances^ 
such,  for  instance,  as  the  condition  of  rest  or  work,  the  kind  of  work,  the 
training,  the  age,  sex,  size  and  weight  of  the  body,  restlessness  or  placidity, 
and  even  the  individual  peculiarities  of  the  person.  As  an  illustration, 
we  will  consider  tlie  body  as  an  engine  and  the  food  consumed  as  the  fuel 
for  the  engine.  It  has  been  proved  as  far  as  possible  that  the  laws  of 
conservation  of  matter  and  energy  are  followed  by  the  human  organism 
as  they  are  in  the  engine ;  the  body  loses  matter  and  energy,  but  they 
undergo  transformation  and  are  not  destroyed  in  the  body.  Reasoning  on 
this  analog^',  it  may  be  assumed  that  whatever  material  is  used  in  the 
body  and  however  much  energA'  is  exhibited  or  heat  evolved  by  it,  both 
matter  and  energy  have  been  derived  from  the  food  consumed  in  the 
process  of  digestion  and  assimilation  and  stored  in  the  tissues. 

Amount  of  Heat  Lost  by  Body — It  is  known  that  the  heat  of  the  body 
is  generated  by  the  oxidation  of  food  or  tissue  substances,  and  also  that  the 
food  required  is  proportional  to  the  extent  of  the  surface  of  the  body. 
For  instance,  a  small  animal  gives  off,  weight  for  weight,  more  heat 
than  a  large  one.  A  large  animal  has  a  smaller  cutaneous  surface  in  pro- 
portion to  size  and  weight  than  a  small  one,  and  a  small  animal  a  rela- 
tively larger  surface  area  than  a  large  one.  For  these  reasons,  it  will 
be  seen  at  a  glance  that  a  thin,  angular,  lean,  lanky  person  loses  more 
*heat,  according  to  weight,  than  a  larger  and  more  rotund  person,  a  thin, 
premnture  infant  more  than  a  plump  and  well-developed  child.  After 
a  consideration  of  many  experiments  on  animals  and  human  beings, 
Camerer  came  to  the  conclusion  that  an. infant  expends  100  calories,  a 
child  of  4  years  expends  91.3  calories,  a  child  of  12  years  expends  57.7 
calories  and  a  man  of  30  years  expends  42.4  calories  per  kilogram  of 
body  weight.     Consequently,  the  amount  of  heat  lost  by  the  body  is  an 


26G  THE    CALORIC    METHOD    OF    FEEDING 

importaut  factor  in  the  regulation  of  food,  and  to  a  great  extent  this  is  ^ 
governed  by  the  area  of  the  body  surface. 

Weight  of  Body. — The  amount  of  food  required  by  the  body,  other 
things  being  equal,  must  be  proportional  to  the  weight  of  the  body.  The 
bodily  heat  is  produced  by  the  oxidation  of  food  consumed  or  stored  in 
tlie  tissues.  In  a  condition  of  rest,  the  tissues  of  the  body  are  not  called 
on  for  the  production  of  heat  and  energy,  but  still  there  must  be  a  mini- 
nmm  of  food  consumed  to  supply  the  energy  utilized  by,  and  the  heat 
radiated  from,  the  body.  In  a  state  of  rest,  a  man  of  154  pounds  weight 
gives  off  15  cubic  feet  of  carbon  dioxid  in  a  period  of  2-4  hours.  The 
production  of  1  cubic  foot  of  carbon  dioxid  by  combustion  is  accompanied 
by  a  liberation  of  heat  equivalent  to  160  foot-tons  of  energ;^',  therefore 
15  X  160  =  2,400  foot-tons  of  energy  which  are  necessary  to  the  main- 
tenance of  the  body  temperature  and  the  performance  of  bodily  functions 
during  the  state  of  rest.  Therefore  1  calorie  is  equal  to  1.54  foot-tons 
of  energ;^',  and  2,400  foot-tons  is  equal  to  about  3,696  calories  for  a  person 
weighing  154  pounds. 

Age. — According  to  Huebner(13),  the  younger  the  animal  organism, 
the  more  rapid  is  the  rate  of  growth.  For  instance,  a  child's  body  grows 
seven  times  more  rapidly  from  one  to  three  months  than  from  six  to 
nine  months  of  age.  It  is  correctly  asserted  that  a  child  commonly  loses 
a  little  weight  for  a  few  days  after  birth ;  but  the  average  increase  of 
weight  up  to  three  months  is  3.6  pounds;  from  the  third  to  the  sixth 
month,  3.6  pounds;  from  the  sixth  to  the  ninth  month,  3.4  pounds:  and 
from  the  ninth  to  the  twelfth  month,  3  pounds.  So  the  amount  of  food 
required  by  a  normal  child  is  in  proportion  to  its  rate  of  growth.  Further 
consideration  of  food  in  childhood  will  be  found  in  Volume  II,  Chap- 
ter XI. 

Sex. — In  anthropometric  tables (14)  that  have  been  carefully  com- 
piled, the  following  data  appear:  (a)  The  most  rapid  growth  occurs  dur- 
ing the  first  five  years  after  birth.  In  the  first  year  the  weight  is  trebled, 
in  the  second  year  it  is  nearly  doubled.  During  this  period  the  rate  of 
growth  is  nearly  identical  in  both  sexes,  only  that  boys  are  a  little  taller 
and  heavier  than  girls,  (b)  During  the  next  period,  from  five  to  ton 
years,  the  growth  of  boys  is  more  rapid  than  that  of  girls,  the  weight  of 
the  former  being  from  2  to  3  poimds  more,  on  the  average,  (c)  During 
the  third  period,  from  ten  to  fifteen  years,  conditions  are  changed,  the 
growth  of  girls  taking  the  lead.  From  the  age  of  twelve  and  a  half  to 
fourteen  and  a  half  years  girls  are  taller  than  boys,  and  from  the  age  of 
twelve  and  a  half  to  fifteen  and  a  half  vears  their  weiijht  exceeds  that 


FACTOKS    GOVEKNING    FOOD    KEQUIKED  267 

of  boys  of  the  same  age  bj  3  or  4  pounds,  (d)  During  the  period  from 
lifteen  to  twenty  years,  boys  again  come  to  the  fore,  and  grow  more 
rapidly  than  girls;  the  weight  of  boys  increases  yearly  at  the  rate  of 
6.0  pounds,  while  that  of  girls  is  2.75  pounds,  (e)  At  the  age  of  twenty- 
three  years,  boys  have  attained  the  limit  of  growth  in  height,  but  in 
breadth  and  weight  they  continue  to  increase.  Girls,  on  the  other  hand, 
at  about  twenty  years  of  age  have  attained  their  full  height  and  weight, 
the  latter  remaining  practically  stationary  until  the  age  of  twenty-five 
or  even  thirty  years.  (/)  In  general,  adults  begin  to  increase  in  weight 
after  thirty-five  years  of  age  at  the  annual  rate  of  three-quarters  of  a 
pound,  a  change  most  often  unwelcome  and  not  of  advantage.  The  rela- 
tive weights  of  men  and  women  of  the  same  age  vary  with  the  height,  up 
to  the  height  of  07  inches,  men  as  a  rule  weighing  more  than  women; 
but  when  over  67  inches  in  height,  women  are  generally  heavier  than 
men  of  the  same  height  and  age,  and  especially  after  middle  life  the 
weight  of  women  may  greatly  increase. 

The  generally  accepted  statement  that  the  quantity  of  food  ingested 
should  be  regulated  by  the  size  and  v^^eight  of  the  body,  offers  no  excep- 
tion as  regards  the  food  of  individuals  of  different  sexes;  the  normal 
height  and  weight  of  a  woman  being  less  than  those  of  a  man,  a  smaller 
quantity  of  food  than  that  required  by  a  man  should  meet  the  needs  of 
the  average  woman.  An  important  point  to  note  is  that  this  smaller 
metabolism  of  food  should  be  looked  at  from  the  standpoint  of  the  per- 
sonal equation  relating  to  the  sex  of  the  individual,  rather  than  the  nor- 
mally lower  average  size  and  weight  of  a  woman.  The  following  table 
illustrates  this  fact  by  showing  the  difference  in  the  quantity  of  food 
taken  daily  by  an  active  man  and  woman  of  identical  age  and  height 
who  were  able  to  maintain  their  nutritive  and  nitrogenous  equilibrium 
upon  the  amounts  here  designated: 

Protein 

Man   100  gm. 

Woman   60  gm. 

Atwater  established  the  principle  that  the  daily  ration  for  a  healthy 
woman  should  be  0.8  of  that  of  a  man.  As  a  general  rule,  it  is  usually 
held  that  a  woman  requires  about  the  same  amount  of  protein  and  energy, 
weight  for  weight,  as  a  man  under  similar  circumstances.  The  amount 
of  energy  required  to  execute  a  definite  amount  of  work  is  the  same, 
whether  it  is  performed  by  a  woman  or  is  done  by  a  man ;  conse(|uentlv, 
the  supply  of  food  should  be  the  same.    Tibbies  says :  "On  the  other  hand, 


Fat 

Carbohydrate 

Gal. 

70  gm. 

400  gm. 

2,700 

67  gm. 

340  gm. 

2,263 

268  THE    CALORIC    METHOD    OF    FEEDI:N^G 

it  frequently  happens  that  the  expenditure  of  energy  on  the  part  of  a 
woman  to  produce  a  definite  amount  of  work  is  greater  than  that  ex- 
pended by  a  man  doing  the  same  identical  work." 

Food  Requirements  as  Influenced  by  the  Internal  Secretions 
OF  Wo]\rAN. — It  is  claimed  that  the  internal  secretion  of  the  ovaries  facili- 
tates the  oxidation  of  carbohydrates  and  the  organized  phosphorus  of  the 
food.  There  are  other  circumstances  in  the  life  of  a  woman  which  influ- 
ence the  demand  for  food.  We  know  that  their  sex  is  subject  to  a  wave 
of  metabolic  activity  which  is  at  its  highest  just  before  each  menstrual 
period.  During  this  metabolic  disturbance  the  organism  calls  for  an 
increase  in  the  nitrogen  metabolism,  and  a  decrease  in  the  carbon  metab- 
olism. There  also  appears  at  this  time  the  formation  of  new  blood  cells, 
with  an  increasing  amount  of  nerve  force  and  general  vigor.  During  the 
menstrual  epoch  there  is  a  small  loss  of  weight  due  to  the  increased  excre- 
tion of  carbonic  acid  and  water,  although  the  protein  metabolism  is 
diminished.  There  is  an  increase  in  weight  during  pregnancy,  notwith- 
standing the  increased  combustion  of  non-nitrogenous  elements;  there  is 
usually  an  increase  in  the  size  of  the  organs  of  lactation  and  parturition 
and  a  deposition  of  fat  in  the  adipose  tissue.  These  metabolic  changes 
call  for  an  increased  amount  of  food  to  the  daily  ration,  which  practically 
means  that  the  woman  should  consume  about  double  the  ordinary  amount 
of  protein,  and  have  a  greatly  increased  amount  of  the  fuel  foods. 

Kind  of  Work. — The  quantity  of  food  necessary  for  an  adult  must  be 
regulated  rather  by  the  amount  of  work  performed  than  by  the  size, 
weight  or  other  characteristics  of  the  body.  These  requirements  of  the 
body  are  analogous  to  those  of  a  machine,  and  well  they  may  be,  as  the 
body  itself  is  a  living  machine.  It  is  a  truism  that  the  greater  the  expen- 
diture of  energy  hy  a  machine  in  the  performance  of  work,  the  more  fuel 
it  will  demand  for  the  generation  of  that  energy. 

The  human  machinery  performs  work  of  two  types,  internal  and 
external  work.  The  internal  work  consists  of  that  done  by  the  organs 
of  digestion,  respiration  and  circulation,  by  the  neuro-muscular  system 
which  maintains  the  body  temperature,  and  muscle  tone;  and  by  the 
glandular  system  in  keeping  up  the  supply  of  the  secretions  and  excre- 
tions. The  external  work  includes  the  activities  of  the  voluntary  mus- 
cular system  and  the  process  of  heat  radiation  from  the  body.  According 
to  Atwater's  experiments,  a  man  at  rest  in  the  respiratory  calorimeter 
liberated  during  two  hours  150  calories;  while  working  a  stationary 
bicycle  for  two  hours,  500  calories ;  and  while  working  the  same  machine 
against  resistance  for  a  period  of  two  hours,  1,000  calories.     It  follows. 


FACTOES    GOVERNING    FOOD    KEQUIKED  269 

therefore,  that  the  supply  of  food  must  keep  pace  with  the.  amount  of 
work  to  be  done,  or  else  the  body  tissues  themselves  will  be  used  up  as 
fuel  for  the  generation  of  the  energy  expended. 

Choice  of  Food. — The  necessity  for  increasing  the  allowance  of  food 
in  proportion  to  the  amount  of  work  the  body  is  expected  to  do  has  always 
been  recognized.  Many  research  workers  have  made  observation  upon 
the  food  consumed  by  individuals  who  were  allowed  a  free  choice  of  food, 
and  found  that,  with  diets  having  the  fuel  values  in  "Standard  Die- 
taries," nutrition  of  such  individuals  was  fairly  normal  and  the  nitrogen 
balance  in  the  state  of  equilibrium.  They  concluded,  therefore,  that  the 
menus  given  fairly  well  represented  the  aliment  required  by  these  persons. 

A  close  study  of  the  table  ^  on  page  270  shows  that  when  Americans  and 
Europeans  are  free  to  choose  their  own  food,  they  seldom  select  that  which 
will  yield  less  than  100  grams  of  protein  per  day. 

When  the  choice  of  food  rests  with  the  individual,  it  is  often  found 
upon  observation  that  a  male  rarely  consumes  less  than  90  grams  of  protein 
per  day.  For  economic  and  other  reasons,  there  are  many  thousands  who 
necessarily  consume  a  much  smaller  quantity,  because  meat,  fish,  fowl, 
milk,  eggs  and  cheese  are  dearer  than  bread,  potatoes,  rice,  oatmeal,  etc. 
]VIaurel(15),  who  has  devoted  much  attention  to  the  subject,  claims  that, 
"to  maintain  the  body  in  nitrogen  equilibrium  when  no  muscular  work  is 
being  performed,  an  adult  in  full  health  and  vigor  weighing  154  pounds 
requires  for  maintenance  105  grams  of  protein  in  a  ration  yielding  about 
2,600  calories  of  energy';  a  woman  weighing  132  pounds  requires  90 
grams  of  protein  in  a  ration  yielding  about  2,200  calories  of  energy." 
Our  experience  leads  us  to  assert  that  these  figures  are  probably  very 
near  the  mark. 

Rubner,  in  studying  the  specific  dynamic  action  of  foodstuffs,  came 
to  the  conclusion  that  each  type  of  food  seemed  to  exert  a  more  or  less 
specific  action  upon  the  energ\'  yielded ;  "so  that,  when  the  foodstuffs  were 
fed  separately,  somewhat  different  energy  values  were  required  for  the 
maintenance  of  body  equilibrium."  He  observed  a  man  who  metabolized 
in  fasting  2,042  calories;  and  when  fed,  2,450  calories;  in  the  form  of 
sugar  alone  he  metabolized  2,087  calories ;  when  fed  2,450  calories  in  the 
foiTn  of  meat  alone,  he  metabolized  2,566  calories.  This  experiment 
clearly  shows  that  the  eating  of  protein  increased  the  metabolism  far 
more  than  could  be  done  by  eating  the  same  number  of  calories  in  the 
form  of  cailx)hydrate  and  fat.  Rubnor  believes  that  this  specific  dynamic 
action  of  protein  involves  the  liberation  of  energy  which  has  not  come  to 

1  Pulletin  No.  52,  p.  24,  U.  S.  Dept.  of  Agric,  and  other  sources, 


270 


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FACTORS    GOVERNING    FOOD    REQUIRED  271 

the  surface  of  the  tissues  aud  which  does  not  directly  contribute  to  the 
support  of  their  activities,  although  it  aids  in  the  maintenance  of  the 
body  temperature.  This  apparent  loss  of  a  part  of  the  fuel  value  of  protein 
of  an  ordinary  mixed  diet  is  not  a  very  important  factor  in  the  total  body 
metabolism,  since  this  specific  dynamic  action  and  the  work  of  digestion 
and  assimilation  together  make  the  total  daily  metabolism  of  energy  only 
about  one-tenth  higher  on  a  maintenance  ration  than  when  no  food  is 
eaten  (Sherman). 

Intensity  of  Muscular  Activity — In  practice,  it  will  often  be  difficult 
to  estimate  the  mechanical  equivalent  of  muscular  work  performed  and 
still  it  is  often  necessary  to  make  use  of  such  indefinite  terms  as  "active," 
"severe,"  etc.,  to  describe  the  intensity  of  the  exertion,  and  thus  indicate 
m  a  general  way  the  amount  of  work  performed. 

Atwater  and  Benedict  (10),  after  a  great  deal  of  research  and  experi- 
mentation, epitomized  the  results  of  many  work  experiments  with  vigor- 
ous young  men  in  the  respiratory  calorimeter,  and  have  derived  the  follow- 
ing estimates  of  the  average  rates  of  metabolism,  under  different  condi- 
tions of  activity : 

Man  sleeping 65  calories  per  hour 

Man  sitting  at  rest 100        "          "       " 

Man  at  light  muscular  exercise 170         "           "       " 

Man  at  active  muscular  exercise 200        "          "       " 

Man  at  very  severe  muscular  exercise.  .  600        "          "       " 

From  these  estimates  the  requisite  rations  may  be  calculated  as  fol- 
lows : 

8  hours  of  sleep  at  65  calories  equal 520  calories 

2  hours'  light  exercise  at  170  calories  equal.  .  .  .  340        " 

8  hours'  active  exercise  at  200  calories  equal .  .  2,320       " 

6  hours'  sitting  at  rest  at  100  calories  equal.  .  .  600       " 


Total  food  requirement  for  the  day 3,780  calories 

If  the  working  day  be  spent  in  severe  muscular  exertions,  the  day's 
ration  would  be  estimated  at  5,060  calories.  The  requisite  amount  of 
calories  for  one  in  sedentary  occupation,  such  as  sitting  at  a  desk,  would 
require  only  2,260  calories. 

Tigerstedt(17)  gives  the  following  estimates  of  food  requirements  for 


272  THE    CALORIC    METHOD    OF    FEEDING 

ditfereut  occupations,  iudicating  the  intensity  of  work  performed  and  the 
caloric  needs: 

2,001-2,400  calories  suffice  for  a  shoemaker 
2,401-2,700       "  "       for  a  weaver 

2,701-3,200       "  "       for  a  carpenter  or  mason 

3,201-4,100       "  "       for  a  farm  laborer 

4,101-5,000       "  "       for  an  excavator 

Over    5,000       "  "       for  a  lumberman 

Graham  Lusk(18)  gives  the  following  estimate  of  food  in  calories  for 
the  requisite  occupations  of  women: 

1,800  calories  suffice  for  a  seamstress  using  a  needle 
1,900-2,100  calories  suffice  for  a  seamstress  using  a  machine 
1,900-2,100       "  "       for  bookbinders 

2,300-2,900       "  "       for  household  servants 

2,600-3,400       "  "       for  washerwomen 

Food  requirements  for  occupations  of  men : 

2,400-2,500  calories  suffice  for  a  tailor 
2,700-2,800       "  "       for  a  bookbinder 

3,100-3,200       "  "       for  metal  workers 

3,200-3,300       "  "       for  a  painter 

4,300-4,700       "  "       for  stonemasons 

5,000-5,400       "  "       for  wood-sawyers 

The  estimated  amount  of  food  in  calories  for  wood-sawyers  emphasizes 
the  fact  that  "wood-sawing  is  a  strenuous  occupation."  This  proverbial 
occupation  has  a  scientific  verification  in  the  above  statement  and  explains 
the  disinclination  of  the  hungry  to  engage  in  this  useful  occupation  as 
well  as  the  unpopularity  of  charitable  wood  yards. 

On  page  273  we  give  a  table,  taken  from  Lusk(19),  of  food  values  with 
cost  per  1,000  calories  for  various  fundamental  foodstuffs  and  the  per- 
centage of  protein  contained  in  1,000  calories. 

The  foods  in  the  following  table  were  purchased  on  the  IN'ew  York  mar- 
kets at  the  prices  named.  If  the  expense  of  cooking  and  serving  and  other 
overhead  charges  be  included,  the  cost  somewhat  increases.  Thus,  at 
Childs'  and  other  similar  restaurants  in  ^N'ew  York,  a  portion  of  pork  and 
beans  served  with  three  slices  of  bread  and  a  pat  of  butter  costs  20  cents, 
representing  a  well-balanced  ration  of  1,000  calories.     The  same  could  be 


FACTORS    GOVEllNING    FOOD    KEQUIKED 
FOOD  VALUES  WITH  COST  PER  1,000  CALORIES 


273 


Foods 


Cost  in  cents  per 

Per  cent  of 

1,000  calories 

calories  in  protein 

IH 

0 

2 

8 

2>i 

12 

2V. 

13 

3H 

0 

4 

19 

4^ 

1 

5 

7 

5^ 

12 

73^ 

0 

TA 

8 

10 

0 

10 

17 

lOM 

34 

11% 

25 

12M 

18 

16^ 

30 

24 

37 

40M 

37 

Glucose 

Corn  meal.  . . . 
Wheat  flour. . . 

Oatmeal 

Cane  sugar .  .  . 
Dried  beans .  . 
Salt  pork  (fat) 

Rice 

Wheat  bread. . 
Oleomargarine 

Potatoes 

Butter 

Milk 

Smoked  ham. . 

Cheese 

Loin  pork .  .  .  . 
Leg  of  mutton 
Sirloin  beef.  .  . 
Turkey 


served  in  the  home  at  a  cost  of  about  10  cents,  and  most  people,  after 
ingesting  such  a  repast  would  feel  comfortably  satisfied.  Of  course,  it  is 
understood  that  this  menu  would  not  satisfy  everybody,  especially  not 
those  in  the  upper  classes  who  demand  the  luxuries  of  the  world  without 
rendering  to  the  world  an  equivalent  therefor. 

Before  leaving  the  subject  of  the  relation  of  muscular  activity  to 
metabolism,  it  may  be  well  to  point  out  that  the  expenditure  of  energy 
in  the  muscular  system  does  not  depend  simply  upon  the  muscular  move- 
ments performed,  but  to  a  considerable  extent  upon  the  degree  of  tension 
or  tone  maintained  in  the  muscle  while  in  a  condition  of  rest.  It  is 
obvious  to  the  surgeon  that  every  living  muscle  is  always  in  a  state  of 
tension  from  the  fact  that  it  gapes  when  its  muscular  sheath  is  cut.  It  is 
equally  true  that  the  degree  of  tension  varies  greatly  under  different  con- 
ditions. Atwater  and  Benedict  observed  the  differences  between  the 
metabolism  of  sleeping  hours  and  that  of  the  hours  spent  sitting  up  with- 
out muscular  movements  which  are  due  largely  to  the  more  complete 
relaxation  of  the  muscles  during  sleep.  From  this  we  find  that  there 
is  in  the  resting  muscles  continual  expenditure  of  energy  which  takes  the 
form  of  muscular  tension  or  tone,  but  ultimately  appears  as  heat,  so  that 
the  heat  production  or  energy  motaboliam  of  the  body  in  a  condition  of 
rest  depends  largely  upon  the  degree  of  tension  which  nonnally  exists 
in  the  muscle. 


274  THE    CALORIC    METHOD    OF    FEEDING 

REGULATION  OF  BODY  TEMPERATURE 

The  regiilatiou  of  body  temperature  has  been  most  ably  discussed 
by  Lu8k(19),  who  avers  that  the  maintenance  of  body  heat  beyond  that  of 
its  usual  environment  requires  a  continual  output  of  energy.  This  outgo 
of  heat  is  controlled  by  mechanisms  which  permit  of  (a)  variations  in 
the  reduction  of  temperature  due  to  the  quantity  of  blood  Drought  to  the 
surface  of  the  skin — radiation,  conduction  and  sweating — which  is  termed 
physical  regulation;  and  {h)  by  variations  in  heat  production  brought 
about  by  an  increase  in  the  rate  of  oxidation  in  the  body  in  response  to 
the  stimulus  of  external  cold,  which  is  termed  chemical  regulation.  The 
increase  in  heat  production  following  the  ingestion  of  food  (already  con- 
sidered in  the  previous  pages  of  this  work)  may  take  the  place  of  "chem- 
ical regulation"  and  thereby  aid  in  the  protection  of  loss  of  body  tempera- 
ture. The  presence  of  a  cushion  of  adipose  tissue  under  the  skin,  together 
with  suitable  clothing  for  the  external  surface  of  the  body  also  helps  to  keep 
down  the  loss  of  heat  to  the  minimum  of  "physical  regulation." 

A  sudden  change  downward  in  the  external  temperature  increases 
the  heat  formation,  augments  the  excretion  of  carbon  dixoid,  and  the 
consumption  of  oxygen  in  warm  blooded  animals.  A  sudden  change 
upward  in  the  atmospheric  temperature  increases  metabolism  in  warm- 
blooded animals,  and  this  change  is  greater  if  the  animal  be  placed  in 
hot  or  cold  water  than  if  it  be  merely  subjected  to  the  influence  of  hot 
or  cold  air. 

Von  Noorden(20)  explains  the  significance  of  an  increase  in  heat 
production  in  cold  weather,  as  due  to  extra  precautions — food,  clothing, 
etc. — to  offset  the  increased  heat  losses  incidental  to  the  external  tempera- 
ture. Senator  was  the  first  to  offer  an  explanation  of  this  phenomenon. 
He  held  that  the  increased  excretion  of  carbon  dioxid  was  due  to  active 
muscular  movements.  Xo  one  at  present  questions  but  "ihat  there  is  an 
increase  of  about  100  per  cent  in  carbon  dioxid  excretion  after  a  cold 
bath,  which  is  due,  no  doubt,  to  active  muscular  movements.  It  may  be 
questioned  that  there  may  be  a  slight  rise  in  carbon  dioxid  excretion 
without  any  visible  movement  or  alteration  in  the  tension  of  the  muscles. 

The  question  of  an  invohmtary  heat  regulation  has  been  definitely 
settled  by  Voit's  animal  experiments  and  also  confirmed  by  Rubner's 
studies.  The  latter  studied  the  metabolism  of  a  man  who  was  kept  in  the 
same  cold  room  with  different  amounts  of  clothing,  and  he  observed  that 
when  the  subject  was  clothed  sufficiently  to  be  C(^mfortable  the  "chemical 
regulation"  was  eliminated.     Rubner  emphasized  the  fact  that  suppres- 


REGULATION    OF    BODY    TEMPEKATURE  275 

sion  of  shivering  and  the  inhibition  of  muscular  activity  when  subjected 
to  external  cold  is  an  unnatural  condition  for  a  person  subjected  to  great 
cold,  and  one  that  never  occurs  noraially. 

Physical  Heat  Regulation — An  increase  in  heat  dissipation  by  means 
of  conduction,  radiation  and  evaporation  comes  into  play  as  Nature's 
means  of  avoiding  overheating;  a  diminution,  on  the  other  hand,  pre- 
vents lowering  of  the  body  temperature.  The  amount  of  heat  present 
in  the  body  falls  imder  the  influence  of  cold,  and  it  does  not  rise,  even 
when  the  individual  is  placed  in  a  warm  bed,  until  active  movements 
again  furnish  the  necessary  amount  of  heat  to  raise  the  temperature 
to  normal.     (Johansson.) 

Chemical  Heat  Regulation — Chemical  heat  regulation,  like  physical 
heat  regulation,  reaches  a  limit  below  which  it  cannot  go.  According  to 
von  Noorden,  "The  chemical  energy  set  free  in  vital  processes  which  is 
inseparably  associated  with  the  development  of  heat,  cannot  go  below  a 
certain  limit.  Only  that  form  of  heat  production  previously  referred  to 
as  being  associated  with  increased  functional  capacity  of  working  organs 
can  be  excluded." 

The  extra  heat  required  during  cold  weather  is,  in  all  probability, 
derived  in  most  part  through  the  activity  of  the  muscles.  It  is  a  matter 
of  every-day  occurrence,  in  cold  climates  during  winter  weather,  to  see 
a  man,  a  wagon-driver,  for  instance,  stop  and  strenuously  exercise  his 
arms — if  he  did  Jiot  do  this,  he  would  sit  on  the  driver's  box  and  shiver — 
a  peculiar  form  of  voluntary  muscular  activity  whose  function  seems  to 
be  to  increase  heat  production  through  increasing  the  internal  work  of  the 
body.  After  all,  it  will  be  seen  that  the  regulation  of  body  temperature, 
even  under  exposure  to  cold,  is  brought  about  by  the  activity  and  tension 
of  the  muscles,  the  relation  of  which  to  metabolism  and  food  requirement 
has  just  been  considered. 

Voit,  in  a  discussion  on  the  "heat  balance"  in  warm  and  cold  climates 
during  both  winter  and  summer,  says  that  involuntary  chemical  heat 
regulation  in  the  cold,  which  he  admits  exists  within  certain  limits,  is 
insufficient  in  the  frozen,  zone.  Here  the  inhabitants  in  addition  to  being 
clothed  in  furs,  are  driven  to  strenuous  exercise  in  order  to  maintain  body 
temperature.  Only  in  so  far  as  the  movements  increased  are  the  food 
requirements  augmented  in  the  Arctic  regions.  The  same  law  holds  good 
in  tropical  countries — the  food  is  lessened  and  the  inhabitants  move  along 
the  lines  of  least  resistance.  The  enormous  amount  of  food  which  the 
Eskimo  can  ingest  with  impunity  has  already  been  referred  to,  and 
emphasizes  the  point  of  the  greater  functional  capacity  of  the  alimentary 


276  THE    CALORIC    METHOD    OF    FEEDIKG 

canal  in  the  natives  of  cold  countries,  as  compared  with  the  abstemious- 
ness of  the  Arab  and  his  ability  to  greater  endurance  of  hunger  and' 
thirst.  Our  digestive  system  and  nervous  mechanism  which  controls  it 
are  affected  both  by  heat  and  cold,  and  as  a  result  most  people  consume 
more  food  in  winter  than  in  summer,  although  the  body  requirements 
remain  practically  the  same  all  the  time. 

The  Surface  Areas  of  the  Skin  in  Heat  Regulation. — The  greatest  loss  of 
heat  is  from  the  body  surface.  Fully  90  per  cent  and  upward  of  the 
whole  amount  takes  place  by  radiation,  conduction  and  evaporation  from 
the  skin.  The  actual  figures  are  given  in-  a  tabulation  on  the  next  page. 
The  reason  the  skin  is  able  to  act  as  one  of  the  most  important  organs  for 
regulating  body  temperature  are:  (a)  that  it  offers  a  large  surface  for 
radiation,  (h)  it  contains  a  large  amount  of  blood,  and  (c)  the  quantity 
of  the  circulating  fluid  is  greater  under  the  circumstances  which  demand 
a  loss  of  heat  and  vice  versa.  The  effects  of  a  hot  atmosphere  on  the  skin 
surf£\ce,  through  the  nerve  fibers,  causes  a  relaxation  of  the  muscular 
fibers  of  the  blood  vessels ;  and,  as  a  result,  the  skin  becomes  full-blooded, 
hot  and  sweating — leading  to  much  loss  of  heat. 

On  the  other  hand,  with  a  low  temperature,  the  blood  vessels  shrink, 
the  skin  becomes  pale  and  cold  and  dry ;  thus  by  means  of  a  self-regulating 
apparatus,  the  skin  is  the  most  important  organ  for  the  regulation  of  body 
temperature. 

It  is  a  recognized  fact  that  size,  height  and  weight  are  important 
factors  in  heat  regulation.  Actual  experiments  upon  animals,  says 
Howell,  "show  that  small  animals  produce  more  heat  in  proportion  to  their 
weight  than  larger  animals  of  the  same  species,  owing  to  the  relatively 
larger  surface,  and,  therefore,  greater  loss  of  heat."  This  point  was  first 
emphasized  by  Riibner  and,  according  to  his  law,  the  metabolism  is  pro- 
portional to  the  surface  area  of  the  body,  or,  in  other  words,  for  the  same 
amount  of  surface  area  there  will  be  the  same  production  of  heat.  On 
the  following  page  will  be  found  a  table  giving  the  surface  area  in  square 
meters  of  people  of  different  heights  and  weights,  showing  the  requisite 
calories  during  a  24-hour  period,  to  which  we  will  refer  later. 

Regulation  of  Heat  loss — The  regulation  of  heat  loss  is  the  most 
important  problem  which  the  physiologists  of  to-day  have  to  elucidate  (21). 
Experiments  plainly  show  that  heat  regulation  is  very  complex ;  the  body, 
as  we  have  just  emphasized,  possesses  a  means  of  controlling  heat  loss  as 
well  as  the  production  of  heat,  and  under  normal  conditions  both  func- 
tions are  in  active  use. 


REGULATION    OF    BODY    TEMPERATURE 


277 


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118 


278  THE    CALORIC    METHOD    OF    FEEDING 

As  we  have  already  seen,  heat  loss  from  our  bodies  is  accounted  for  as 
follows : 

(a)   From  expirations  from  the  lungs. 

(&)   By  evaporation  of  sweat  from  the  skin. 

(c)   By  conduction  and  radiation  from  the  skin. 

{d)   Through  the  excreta,  urine,  feces,  saliva. 

The  approximate  percentages  of  heat  lost  in  this  manner,  according 
to  Vierodt,  are  as  follows: 

(a)  From  expirations  from  lungs 3.5  per  cent  or      84  cal. 

(6)  Vaporization  of  water  from  lungs 7.2    "       "      "      182     " 

(c)  By  evaporation  from  the  skin 14.5    "       "      "      364     " 

(d)  By  conduction  and  radiation  from  skin 73.0    "       "      "1,792     " 

(e)  By  urine  and  feces 1.8    "       "      «       48     « 

Total  daily  loss 2,470  cal. 

Howell,  in  commenting  on  this  observation,  says  the  relative  import- 
ance of  these  factors  will,  of  course,  vary  with  conditions ;  for  instance, 
a  high  external  temperature  will  aid  in  the  diminishing  loss  from  radia- 
tion, while  increasing  that  from  evaporation,  owing  to  the  greater  pro- 
duction of  sweat. 

Many  examples  may  be  given  of  the  power  which  the  body  possesses 
of  resisting  the  effects  of  a  high  temperature,  in  virtue  of  evaporation 
from  the  skin.  Blagden  and  others  supported  a  temperature  varying 
between  02°-100°  C.  (108°-212°  F.)  in  dry  air  for  several  minutes; 
and  in  a  subsequent  experiment  the  former  remained  eight  minutes  in  a 
temperature  of  126.5°  C.  (260°  F.).   According  to  Carpenter: 

The  workmen  of  Sir  F.  Chantrey  were  accustomed  to  enter  a  furnace, '  in 
which  his  molds  were  dried,  while  the  floor  was  red  hot,  and  a  thermometer  in 
the  air  stood  at  177.8°  C.  (350°  F.),  and  Chabert,  the  fire-king,  was  in  the  habit 
of  entering  an  oven,  the  temperature  of  which  was  from  205°-315°  C.  (400°- 
600°   F.)      (Carpenter.) 

But  such  heats  are  not  tolerable  when  the  air  is  moist  as  well  as  hot, 
though  this  condition  prevents  evaporation  from  the  body.  C.  James 
states  that,  in  the  vapor  baths  of  N'ero,  he  was  almost  suffocated  in  a  tem- 
perature of  44.5°  C.  (112°  F.),  while  in  the  caves  of  Testaccio,  in  which 
the  air  is  dry,  he  was  but  little  incommoded  by  a  temperature  of  80°  C. 
(176°  F.).  In  the  former,  evaporation  from  the  skin  was  impossible; 
in  the  latter  it  was  abundant,  and  the  layer  of  vapor  which  would  rise 
from  all  the  surface  of  the  body  would,  by  its  slowly  conducting  power, 


KEGIILATIOX    OF    BODY    TEMPEKATUHE  279 

defend  it  for  a  time  from  the  full  action  of  the  external  heat.  (Kirk's 
^'Handbook  of  Physiology.") 

Under  ordinary  conditions  we  are  able  by  suitable  clothing  to  increase 
or  diminish  the  amount  of  heat  lost  by  the  skin.  The  ways  by  which  the 
skin  may  be  rendered  more  efficient  as  a  cooling  apparatus,  too,  by  ex- 
posure, by  baths,  and  by  other  means  which  man  instinctively  adopts  for 
lowering  his  temperature  when  necessary,  are  too  well  known  to  require 
more  than  passing-  mention. 

Production  of  Heat  During  Rest — The  production  of  heat  during  rest 
varies  in  different  individuals  according  to  height,  weight,  to  the  super- 
ficial area  of  their  bodies,  and  to  their  condition  of  health. 

In  the  following  table  is  reproduced  the  metabolism  of  adult  males 
per  minute — worked  out  according  to  Zunt's  method.  The  subjects  of 
these  experiments  were  in  absolute  muscular  rest  during  the  observation. 
The  age,  height  and  weight  are  recorded,  the  respiratory  quotient  ascer- 
tained, and  the  total  calories  for  the  twenty-four  hours  estimated  and  the 
calories  per  hour  per  kilogram  of  body  weight.  The  minimum  resting 
metabolism  is  estimated  by  measurement  of  the  gaseous  interchange  during 
sleep  or  during  fasting,  at  least  twelve  hours  after  the  ingestion  of  food. 
Von  Noorden(20)  in  his  research  on  this  point  "replaces  the  quantity 
of  carbon  dioxid  excreted  by  the  heat  factor  which  can  be  deduced  from 
the  ratio  existing  between  the  quantity  of  carbon  dioxid  eliminated  and 
the  amount  of  heat  formed  during  twenty-four  hours."  Atwater's  calori- 
metric  experiments  are  especially  valuable,  both  on  account  of  the  care 
with  which  they  were  carried  out  and  by  reason  of  their  repeated 
repetition. 

The  table  on  the  following  page  shows  height,  weight  and  the  area 
of  body  surface  in  square  meters,  the  calories  per  hour  per  kilogram  of 
body  weight  and  total  calories  for  the  twenty-four  hour  period.  Even 
these  numbers  derived  from  resting  metabolism,  possibly  do  not  represent 
the  minimal  metabolism  during  rest,  since  deep  sleep  does  not  usually 
extend  over  more  than  from  six  to  eight  hours. 

Resume. — From  previous  discussion  of  this  subject,  it  will  be  observed 
that  although  individuals  of  excessive  weight  have  a  gi'eater  metabolism 
than  those  of  slighter  build,  yet  the  metabolism,  according  to  von  I^oorden, 
does  not  increase  in  direct  proportion  to  weight,  but  less  rapidly.  There- 
fore, when  considering  the  unit  of  weight  to  metabolism,  it  is  well  to  recol- 
lect it  is  usually  smaller  in  the  case  of  heavy^  than  of  light  individuals. 
It  will  be  seen,  from  carefully  studying  the  table,  that  absolute  metabolism 
does  not  run  parallel  with  body  weight,  but  more  nearly  proportionally 


280 


THE    CALORIC    METHOD    OF    FEEDING 


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HEGITLATIOX    OF    BODY    TEMPERATURE  281 

with  the  surfac'O  area  of  the  body.  Bergman  was  convinced  of  this  fact 
several  decades  ago,  and  Rubner  and  von  Noorden  have  confirmed  it  by 
numerous  experiments. 

Again  we  reiterate  that  a  tall  thin  man  has  a  greater  area  of  body 
surface  for  a  given  weight  than  a  short  stout  man.  ''Besides,  normal  men 
may  vary  as  much  as  10  per  cent  from  the  average  in  relation  of  surface 
area  to  body  weight.  The  spare  thin  man,  besides  having  a  greater  surface 
area,  also  differs  from  the  stout  short  man  in  that  he  has  a  greater  per- 
centage of  actual  protoplasm."  Now,  since  the  metabolism  of  the  body 
depends  upon  its  weight  of  protoplasm  (active  tissue)  rather  than  total 
corporeal  weight,  we  have  here,  according  to  Sherman (4),  an  important 
reason  for  assuming  that  the  food  requirement  will  be  greater  in  the  tall 
than  in  the  short  individual  of  the  same  weight.  Von  !N^oorden  tested  this 
question  by  observing  two  individuals  of  the  same  weight  but  different 
build  for  a  period  of  one  day.    His  results  were  as  follows : 

Thin  man Weight,  71.0  kilo.,  2,392  cal.,  33.6  cal.  per  kilo. 

Stout  man Weight,  73.6  kilo.,  2,136  cal.,  29.0  cal.  per  kilo. 

Finally,  for  the  majority  of  individuals,  it  will  be  safe  in  calculating 
a  dietary  to  proceed  as  if  the  form,  height,  weight  and  body  surface  area 
were  constant  without  falling  into  serious  error. 

REFERENCES 

1.  Atwater.    Methods  and  Results  of  Investigations  on  the  Chemistry 

and  Economy  of  Food,  Office  of  Exper.  Sta.,  U.  S.  Dept.  Agric, 
1805,  Bull.  No.  21;  Neue  Versuche  ueber  Stoff-  und  Kraft- 
wechsel,  Ergebn.  d.  Physiol.,  vol.  iii,  1904. 

2.  Laxgworthy.     Digest  of  Metabolism,  U.  S.  Dept.  of  Agric,  1898, 

Exper.  Bull.  No.  45. 

3.  Atwater  and  Snell.    J.  Amer.  Chem.  Soc,  July,  1903. 

4.  Sherman.     Chemistry  of  Food  and  Nutrition. 

5.  Hall,  Winfield  S.     Nutrition  and  Dietetics,  New  York,  1913. 
fi.     RvBNER.     Ztsch.  f.  Biol.,  1885,  vol.  xxi,  pp.  250-257. 

7.  Chittenden.     The  Nutrition  of  Man. 

8.  TiBBLES,  William.     Food  in  Health  and  Disease. 

9.  Rubner.     Ztsch.  f.  Biol.,  vol.  xlii. 

10.     Beaumont.     Physiology  of  Digestion,  pp.  9-115,  Plattsburgh,  1833, 
Amer.  J.  Physiol.  1,  p.  374,  1898. 


282  THE    CALORIC    METHOD    OF    FEEDIXG 

11.  Caisnoa",  W.  B.     The  Mechanical  Factors  of  Digestion,  New  York, 

1911. 

12.  Locke,  E.  A.     Food  Values,  pub.  by  D.  Appleton  &  Co.,  1915. 

13.  Huebnp:r.     Deutsch.  med.  Wochenschr. 

14.  TiBBLEs.     Loc  cit.,  p.  86. 

15.  Maurel.     Rev.  Soc.  scient  d'hyg.  aliment,  1906. 

16.  Atwatee  and  Bexedict.     Exper.  Sta.,  U.  S.  Dept.  Agric,  Bull. 

Nos.  44,  63,  69,  109,  136. 

IT.  TiGERSTEDT.     Text-book  of  Physiology. 

18.  LusK,  Graham.     Med.  Rec,  April  25th,  1914. 

19. .     The  Elements  of  the  Science  of  Kutrition. 

20.  vox  XooRDEN.     Metabolism  and  Practical  Medicine. 

21.  Howell,  W.  H.     Text-book  of  Physiology. 


BIBLIOGRAPHY 

Abderhalden.     Handbiich   der  biochemischen  Arbeitsmethoden,    1910, 

Bd.  III. 
Armsby.     Principles  of  Animal  Nutrition,  Chaps.  7  to  10. 
Atwater.     Methods  and  Results  of  Investigation  on  the  Chemis-ry  and 

Economy  of  Food,  Office  of  Exper.  Sta.,  U.  S.  Dept.  of  Agric, 

1895,  Bull.  Xo.  21. 

.     Ihid. 

.     Xeue  Versuche  ueber  Stoff-  und  Kraftwechsel,   Ergeb.   d. 

Physiol.  3,  1904. 
and  LaxCtWorthy.    A  Digest  of  Metabolism  Experiments,  U.  S. 

Dept.  of  Agric,  1898,  Bull.  No.  45,  Office  of  Exper.  Sta. 
and  Benedict.  A  Respiration  Calorimeter  with  Appliances  for 


the  Direct  Determination  of  Oxygen,  Carnegie  Institution  of 
Washington,  1905,  Pub.  No.  126. 

Bexedict  and  Carpexter.  The  Metabolism  and  Energy  Transforma- 
tions of  Healthy  Men  During  Rest.     Ihid. 

Fisher.  A  New  Method  for  Indicating  Food  Values,  A.  J.  Physiol.,  vol. 
XV,  417. 

LusK.    Elements  of  the  Science  of  Nutrition,  2d  ed.,  1909,  pp.  17-45. 

Mexdel  and  Swaetz.  The  Physiological  Utilization  of  Some  Complex 
Carbohydrates,  A.  J.  Med.  Sci.,  March,  1910. 

Murlix.  The  Nutritive  Value  of  Gelatin,  Am.  J.  Physiol.,  xix,  285-313; 
XX,  234-258,  1907-1908. 


BIELIOGKAPIIY  283 

N'agel.     Handbiich  der  Physiologie  des  Menschen,  1909,  pp.  331-375. 

Oppenheimek.     Handbiich  der  Biochemie,  II,  1-92. 

Reitz  and  Mitchell.     On  the  Metabolism  Experiment  as  a  Statistical 

Problem,  J.  Biol.  Chem.,  8,  297-326,  190. 
RuBNER.    Der  Energiewert  der  Kost  des  Menschen,  Ztsch.  f.  Biol.  (n.  f.), 

24,  201-308  (901). 
.     Die    Gesetze    des    Energieverbraiiches    bei    der    Ernahriing 

(1902). 
Tallqvist.     Ziir  Frage  des  Einflusses  von  Fett  and  Kohlenhydrat  aiif 

den  Eiweissumsatz. 
TiGEKSTEDT.    Tcxt-book  of  Physiology,  1906,  Chapter  4. 
VoiT.    Arch.  f.  Hyg.,  41,  1902,  177-189. 
and  ZisTERER.     Bedingt   die  verschiedene  Ziisammensetziing 

der  Eiweisskorper  aiich  einen  Unterschied  in  ihrem  Nahrwert? 

Ztschr.  f.  Biol.  (K  F.) 
voisr  IsTooRDEx.    Metabolism  and  Practical  Medicine,  vol.  i,  pp.  185-207. 
Watson  and  Hunter.     Observations  on  Diet.     The  Influence  of  Diet  on 

Growth  and  Nutrition,  J.  Physiol.,  vol.  xxxiv,  pp.   111-132, 

1906. 


\ 


CHAPTER  X 


GENERAL    NUTRITION   AND   MINERAL    METABOLISM 

General  Considerations. 

Metabolism:  Anabolism  and  Catabolism. 

Metabolism  Experiments:  Balance  of  Income  and  Outgo;  Respiratory 
Quotient. 

Factors  Which  Affect  Metabolism:  Consumption  of  Food;  Fasting;  Effect 
of  Nitrogenous  Diet  on  Metabolism;  Carbohydrates  as  Protein 
Sparers;  Fat  Versus  Carbohydrates  as  Protein  Sparers;  Gelatin  as  a 
Protein  Sparer;  Alcohol  as  a  Protein  Sparer;  Metabolism  of  Water; 
Metabolism  of  Mineral  Substances;  Acid-Forming  and  Base-Forming 
Elements. 

GENERAL    CONSIDERATIONS 

In  the  study  of  metabolism,  we  become  acquainted  with  the  exchanges 
of  material  by  which  vital  phenomena  are  produced,  and  the  conversion  of 
chemical  force  into  "living  energy."  The  various  metabolic  processes 
are  not  the  same  in  all  organs  and  tissues.  For  instance,  the  functions  of 
the  liver  and  of  the  pancreas  are  distinctly  different.  Valuable  data  have 
been  obtained  by  physiologists  who  have  painstakingly  studied  the  meta- 
bolic changes  in  isolated  parts  of  the  body.  By  the  maintenance  of  arti- 
ficial circulation  through  "surviving"  organs,  completely  severed  from 
their  normal  relations,  the  life,  of  the  cells  may  be  continued  for  many 
hours.  Chemical  examination  of  such  tissues  has  thrown  light  on  their 
metabolic  processes ;  under  such  conditions  changes  in  the  composition  of 
the  nutrients  in  the  circulating  medium  point  to  the  nutrient  demands, 
the  waste,  or  the  specific  elaborations  of  the  cells.  Furthermore,  by  the 
exclusion  of  individual  organs,  their  normal  activity  may  be  inferred  from 
the  absence  of  certain  functions.  The  metabolic  work  of  the  spleen, 
kidneys  and  thyroid  has  been  studied  by  observations  on  individuals  who 
have  in  whole  or  in  part,  been  deprived  of  these  organs  through  surgical 
intervention.  Moreover,  the  changes  in  metabolism  which  go  hand-in- 
hand  with  diverse  pathological  conditions  of  the  body  have  also  con- 
tributed to  our  understanding  of  the  subject. 

285 


286  NUTRITION  AND  MINERAL  METABOLISM 

It  is  readily  understood  that  many  difficulties  beset  the  path  of  the 
investigator  who  studies  the  metabolism  of  individual  organs,  although 
the  problems  involved  are  of  the  greatest  importance  in  physiology.  Pro- 
fessor Lafayette  B.  Mendel,  in  discussing  this  question,  says : 

The  income  (food  and  oxygen)  and  the  outgo  (excretions,  urine  and  feces) 
have  been  determined  with  accuracy,  under  the  most  varied  conditions,  while  the 
understanding  of  the  intermediate  processes  is  still  largely  a  matter  of  "gaps  and 
guesses."  The  body  is  constantly  undergoing  losses,  which  must  be  made  good 
sooner  or  later.  Xew  material  must  be  contributed  to  replace  the  wear  and  tear 
of  the  body.  Certain  losses  may  only  be  temporary,  as  in  the  secretion  of  milk, 
the  production  of  eggs,  the  ejection  of  semen,  and  the  menstrual  flow,  all  of  which, 
however,  are  relatively  of  little  importance.  The  lungs  give  off  carbon  dioxid  and 
water,  the  kidneys  water,  inorganic  salts  and  nitrogenous  compounds.  The  skin 
eliminates  water  and  inorganic  salts  and  traces  of  nitrogenous  compounds,  and 
with  the  feces  there  is  excreted  a  residue  of  the  digestive  secretions,  waste  from 
the  alimentary  canal  and  indigestible  particles  of  food. 

METABOLISM 

In  the  study  of  the  intricate  processes  of  digestion,  assimilation  and 
absorption,  we  traced  the  food  through  the  digestive  tract,  and  we  come 
now  to  a  consideration  of  those  processes  which  are  fundamentally  im- 
portant ones — the  fate  of  the  foodstuffs  in  metabolism,  all  others  being 
only  means  leading  toward  the  end.  During  digestion,  assimilation,  res- 
piration and  excretion,  the  food  ingested  undergoes  many  and  various 
changes,  breaking  down  into  simpler  compounds  or  undergoing  transmu- 
tation into  more  complex  substances.  This  change(l)  of  matter  into 
potential  and  dynamic  energy  is  termed  metabolism.  The  body  converts 
potential  into  kinetic  energy  by  metabolism  in  the  body.  The  potential 
energ\^  of  the  aliment,  through  the  processes  of  digestion,  is  transformed 
into  the  actual  energy  of  heat  and  mechanical  labor.  There  is  no  dif- 
ference in  these  changes  between  man  and  other  vertebrates,  though  there 
may  be  slight  variations  in  details ;  the  end  products  are  the  same.  It  is 
admitted  that  there  may  be  slight  differences  in  the  nervous  and  intel- 
lectual processes,  though  at  present  this  is  "seen  through  a  glass  darkly." 

Anabolism  and  Catabolism — For  the  sake  of  clearness,  these  chemical 
changes  are  classified  as  follows : 

First,  there  are  certain  chemical  processes  in  the  animal  economy 
where  simpler  substances  are  converted  into  more  complex  ones,  which  is 
constructive  metabolism,  i.e.,  the  process  of  the  assimilation  of  nutritive 
material  from  the  alimentary  canal  and  its  conversion  into  the  living 
substance.    This  process  is  called  anabolism.    An  example  of  this  upbuild- 


METABOLISM  287 

ing  metabolic  change  is  found  in  the  first  change  which  the  fats  undergo 
after  saponification.  This  change  has  already  been  explained  (in  Vol- 
ume I,  Chapter  VII,  The  Physiology  of  Absorption,  to  which  the  reader 
is  referred).  In  this  anabolic  change  the  fatty  acids  combine  with 
glycerin  to  form  molecules  of  neutral  fat.  The  latter  molecule  contains 
three  parts  of  fatty  acid  to  one  of  glycerin,  and  is  therefore  much  more 
complex  than  the  molecules  from  which  it  is  built  up. 

Second,  the  complex  food  materials  or  tissue  constituents  are  oxidized 
and  broken  down  into  simpler  materials,  and  finally  excreted.  Preceding 
this  oxidative  change,  the  energy  of  the  complex  material  is  given  up  in 
the  form  of  heat,  motion,  etc.  The  body  is  never  stable ;  while  growth  and 
nutrition  progress,  destruction  or  demolition  constantly  go  on.  This 
retrograde  metabolism  is  called  catabolism,  and  most  of  the  chemical 
changes  taking  place  in  the  animal  body  belong  to  this  group. 

It  is  readily  seen  that  analysis  and  synthesis  play  their  part  coinci- 
dently  or  successively  in  the  various  phases  of  the  activity  of  the  living 
substance ;  and  when  the  effects  of  destructive  or  catabolic  change  are 
no  longer  offset  by  appropriate  anabolic  processes,  the  functions  may  be- 
come impaired  or  may  cease  altogether.  It  will  be  seeuy  therefore,  ttiat 
the  continuity  of  life  depends  upon  perfect  metabolism.  Indeed,  it  is 
well  said  that  "metabolism,  in  its  entirety,  is  made  up  of  a  series  of 
processes  both  catabolic  and  anabolic.  In  vegetable  life  the  synthetic 
changes  predominate,  and  highly  complex  compounds  are  built  up,  one 
might  say,  directly  from  the  elements"(2).  In  animal  life,  on  the  other 
hand,  catabolism  prevails  to  a  large  extent,  so  that  in  these  late  years 
physiologists  are  accustomed  to  point  out  quantitative  rather  than  quali- 
tative differences  between  animal  and  vegetable  life.  Foodstuffs,  for 
instance,  are  ingested  in  the  form  of  complex  molecules  of  carbohydrate, 
fat  and  protein,  and  during  the  varied  processes  of  digestion,  absorption 
and  assimilation  undergo  more  or  less  complete  combustion.  Oxygen 
unites  with  carbon  to  form  carbon  dioxid  and  with  hydrogen  to  form 
water;  the  nitrogen  of  the  highly  complex  protein  substances  reappears 
in  combination  with  carbon,  hydrogen  and  oxygen,  as  urea,  uric  acid, 
hippuric  acid,  etc.,  and  the  sulphur  and  phosphorus  of  organic  compounds 
are  eliminated  after  oxidation  to  sulphuric  acid.  It  is  through  these 
catabolic  processes  that  the  potential  energy  of  the  foodstuffs  is  ultimately 
transformed  to  maintain  body  temperature,  nitrogen  equilibrium,  and 
furnish  the  necessary  energy  for  the  wear  and  tear  of  the  body.  In  the 
cleavage  of  complex  compounds  to  simpler  ones,  a  portion  of  the  potential 
energy  of  the  ingested  food,  perhaps  stored  up  temporarily  in  the  form 


288 


NUTRITION  AND  MINERAL  METABOLISM 


of  glycogea  or  tissue  fat,  becomes  kinetic.  In  some  cases  the  combustion 
proceeds  to  the  same  end-products  which  rise  by  oxidation  outside  of  the 
body,  or,  again,  the  compounds  which  are  discharged  by  the  elimination 
of  the  products  of  catabolic  changes  may  be  completely  oxidized  or  even 
undergo  subsequent  synthesis,  as  is  true  of  such  substances  as  urea  and 
hippuric  acid. 

METABOLISM   EXPERIMENTS 

Balance  of  Income  and  Outgo. — A  balance  sheet  of  the  anabolic  income 
and  the  catabolic  outgo  will  graphically  show  the  exact  amount 
of  matter  and  einergy  used  daily  in  the  body.  According  to  Tib- 
bles(l),  the  income  consists  of  (a)  matter:  food,  drink  and  oxygen  of 
the  air;  (&)  energy:  the  potential  energy  of  food  and  drink.  The  outgo 
consists  of  (a)  matter:  in  the  urine,  feces,  perspiration  and  breath:  (&) 
energy:  the  potential  energy  of  urine,  feces,  products  of  perspiration  and 
respiration.  A  scientific  balance  sheet  of  this  process  would  graph- 
ically "show  the  amount  of  C,  N,  H,  O,  P,  S,  CI,  K,  Na,  Mg,  and  Fe  in 
the  income  and  outgo,  and  it  would  also  show  the  compounds  in  the  ex- 
creta, including  proteins,  fats,  carbohydrates,  water  and  carbon  dioxid." 

Many  observers  have  worked  over  this  problem.  Two  of  the  most 
explicit  results  are  the  following,  given  below.  The  first  of  Ranke(3), 
the  second  by  Pettenkofer  and  Voit(4),  as  shown  in  the  following  tabu- 
lation from  Tibbies  (1)  : 

EXCHANGE  OF  MATERIAL  WITH  STANDARD  DIETS 


Income 

Expenditure 

Food 

Amount 

in 

Gms. 

Nitro- 
gen 
(Gms.) 

Carbon 
(Gms.) 

Excretions 

Nitro- 
gen 
(Gms.) 

Carbon 
(Gms.) 

Water 
(Gms.) 

Protein 

100 
100 
250 

15.5 

53.0 
79.0 
93.0 

Urine 

Feces 

Respiration 
(CO2) 

Total 

14.4 
1.1 

6.16 

10.84 

208.00 

Fat 

Carbohydrate 

Tota' 

15.5 

225.0 

15.5 

225.00 

Protein 

137] 
117 
352  J 
2016 

19.5 

315.5 

Urine 

Feces 

Respiration.... 

Total 

17.4 
2.1 

12.70 

14.50 

248.60 

1279 

Fat 

83 

Carbohydrate 

Water 

828 

Total 

19.5 

315.5 

19.5 

275.80 

2190 

METABOLISM    EXPERIMENTS 


289 


The  researches  and  results  of  these  men,  now  classical,  have  never 
been  assailed ;  but  they  are  not  so  complete  as  the  researches  conducted  by 
Atwater(5)  and  his  coworkers.  Few  investigators  have  carried  out  their 
experiments  with  the  completeness  of  those  conducted  by  Atwater  from 
1897  to  1907.   Atwater  and  his  colleagues  selected  for  their  observatio?is 


Fig.  5. — Calorimeter.— Devised  by  Atwater  and  Rosa,  Bull.  63,  U.  S.  Dept.  Agric, 
1899.  Recent  improvements  on  same  by  Atwater  and  Benedict — "A  Respiration 
Calorimeter" — Carnegie  Institution  of  Washington,  1905,  used  in  Howell's  Physi- 
ology, 6th  Edition,  Saunders,  1915. 


a  man  in  normal  health,  with  good  digestion.  A  well-balanced  palatable 
dietary  was  provided;  it  was  well  cooked,  accurately  sampled,  and  care- 
fully analyzed.  The  quantities  of  nitrogen  and  carbon  were  sufficient  to 
maintain  equilibrium  during  work  or  rest.  Four  days  before  the  experi- 
ment was  begim  a  preliminary  digestion  experiment  was  made  to  determine 
the  requisite  food  for  equilibrium  maintenance. 


290 


:nutiutio2n[  and  mia^ekal  metabolism 


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O     O 

rr 

e 

"" 

=5'  c  1 

3  o  :2 

m  >  H 

•-I  N  fS 


— '  ?i  /^  a;  ^  <K 

—  "^  r:  _-  ^ 

—  3  c  -;  —  G 
«  «  O  :=  «  es 

te  «  t>  H  w  « 

■^  lO  ea  t.  X  a 


292  NUTRITION  AND  MINERAL  METABOLISM 

During  these  preliminary  digestion  experiments  the  man  was  ordered 
to  work  and  rest  just  as  he  was  to  do  while  in  the  respiratory  calorimeter, 
shown  in  the  accompanying  illustration (6). 

The  results  of  some  of  these  calorimetrie  investigations  are  given  in 
the  following  tables,  a  study  of  which  will  show  that  the  body  has  con- 
siderable power  of  adjusting  the  expenditure  of  nitrogen  to  the  income. 
The  catabolized  protein  cannot  be  calculated  as  an  exact  measure  of  per- 
manent demands  of  the  body,  nor  as  a  measure  of  the  usual  requirements 
of  a  man  at  work ;  but  experiments  of  this  type  show  that  the  body  re- 
quires a  specific  quantity  of  energy-producing  foodstuffs  for  sustenance, 
and  an  additional  amount  to  supply  the  demands  for  bodily  wear  and 
tear. 

According  to  Atwater,  the  results  of  a  rest  experiment  during  a  period 
of  45  days  were  as  follows:  Net  income,  2,255  calories;  net  expenditure, 
2,255  calories.  During  a  period  of  light  work  lasting  for  65  days,  the 
net  income  amounted  to  2,690  calories,  the  net  expenditure  to  2,628  calo- 
ries. During  the  45  days  of  rest  the  elimination  of  energy  was  estimated 
to  be :  By  the  skin  and  lungs,  1,669 ;  in  the  evaporation  of  water  from 
the  lungs,  550 ;  in  the  urine  and  feces,  31 ;  total,  2,250  calories.  During 
a  period  of  20  days  of  work  the  heat  eliminated  by  means  of  radiation 
and  conduction  from  the  skin  and  air  in  the  lungs  amount  to  2,777 ;  in 
the  evaporation  of  water  from  the  lungs,  1,126 ;  in  the  urine  and  feces, 
19;  by  muscular  work,  234;  total,  3,656  calories. 

The  Respiratory  Quotient. — It  has  always  been  held  that  the  energy 
expended  by  the  body  is  measured  by  the  quantity  of  carbon  dioxid  ex- 
creted. Parkes  determined  that  during*  rest  a  man  of  150  pounds  ex- 
creted daily  15  cubic  feet  of  carbon  dioxid ;  that  1  cubic  foot  of  gas  re- 
sulting from  combustion  meant  the  expenditure  of  160  foot-tons  of  energy, 
and  15  cubic  feet  2,400  foot-tons  of  energy,  the  equivalent  of  about  1,560 
calories.  He  estimated  the  amount  of  carbon  dioxid  excreted  hourly  dur- 
ing a  period  of  rest  to  be  0.62  cubic  feet ;  during  a  period  of  hard  work, 
1.66 ;  and  during  laborious  work,  2.75  cubic  feet.  Atwater  and  Benedict 
proved  that  carbon  dioxid  excretion  varies  with  the  condition.  The  aver- 
age daily  amount  during  rest  and  fasting  was  676  grams ;  during  rest 
with  food,  812  grams;  during  work  with  carbohydrate  diet,  1,820  grams; 
during  work  with  fat  diet,  1,665  grams;  and  during  work  with  mixed 
diet,  1,475  grams.  Parkes  estimated  the  daily  expenditure  of  energy  dur- 
ing rest  to  be  1,600  calories;  during  moderate  work,  2,600;  and  during 
"hard  work,  3,200  calories. 

The  significance  of  the  respiratory  quotient  in  metabolism  has  been 


METABOLISM   EXPERIMENTS 


293 


studied  extensively  by  Zuntz(7)  of  Germany  and  Atwater(5)  in  this 
country.  The  respiratory  quotient  is  the  most  delicate  test  of  the  car- 
bonaceous metabolism  of  the  organism ;  it  is  the  ratio  of  the  carbon  dioxid 
exhaled  to  the  oxygen  consumed.  Correct  values  for  the  gaseous  inter- 
change and  for  the  respiratory  quotient  can  be  obtained  only  when  delicate 
technical  precautiops  are  observed — with  the  Atwater-Rosa  calorimeter, 
or  by  Zuntz's  method.  Atwater  at  the  beginning  of  each  experiment 
directs  (for  a  period  of  from  three  to  ten  minutes,  varying  with  practice 
and  with  the  capability  of  control  on  the  part  of  the  individual  examined) 
that  the  ventilation  is  to  be  slightly  increased,  and  as  a  result  of  the  greater 
activity  of  the  respiratory  musculature,  the  consumption  of  oxygen  is 
raised  somewhat  above  the  amount  consumed  during  rest.  Von  Noorden 
says,  "As  a  result  of  the  forced  respiration,  too  much  carbonic  acid  is  with- 
drawn from  the  blood,  and  so  the  respiratory  quotient  is  found  to  be  too 
high.  Subsequent  to  the  period  of  forced  respiration,  there  follows  for 
some  minutes  one  of  quieter  respiration,  during  which  there  is  a  com- 
pensatory diminution  in  the  carbon  dioxid  output,  below  the  amount  that 
is  formed,  with  the  result  that  the  respiratory  quotient  is  too  low.  Only 
after  these  two  periods  are  passed  does  the  gaseous  exchange  become 
regular  and  the  normal  values  for  O2,  CO2,  and  the  respiratory  quotient 
can  be  determined." 

The  respiratory  quotient  is  affected  by  numerous  other,  frequently 
accidental,  influences,  apart  from  the  purely  mechanical  ones  associated 
with  respiration,  and  so  conclusions  can  be  drawn  only  when  the  results 
obtained  by  numerous  experiments  are  found  to  agree. 

The  tabulation  below  from  the  experiments  of  Atwater  and  Benedict  * 
shows : 

EFFECTS  OF  FOOD  AND  WORK  ON  RESPIRATION 


Conditions 

Heat 
measured 
(Calories) 

CO2 
exl^led 
(Liters) 

Oxygen 

consumed 

(Liters) 

Respiratory 
quotient 

Rest:  Fasting 

"       Ordinary  mixed  diet .  . 
Moderate  work: 

Fat  diet 

2,197 

2,287 

3.570 
3,699 

5,128 
5,142 

342.2 
404.5 

613.9 
655.1 

856.6 
929.2 

473.6 
469.4 

737.5 
757.1 

1,058.9 
1,025.9 

.727 
.862 

.832 

Carbohydrate  diet — 
Hard  work: 

Fat  diet 

.865 
.809 

Carbohydrate  diet 

.906 

1  Bull.  109,  U.  S.  Dept.  Agric. 
119 


294  KUTRITIOIC  AND  MINERAL  METABOLISM 

The  respiratory  quotient  is  calculated  as  follows:  Divide  the  amount 
of  carbon  dioxid  exhaled  by  the  amount  of  oxygen  consumed;  one  liter 
of  carbon  dioxid  weighs  1.9642  grams,  and  one  liter  of  oxygen  1.4286 
grams,  and  the  corresponding  factors  are  1  -^  1.9642  =  0.5091,  and 
1  -^  1.4286  =  0.7.  The  amount  of  carbon  dioxid  exhaled  by  a  man  in 
one  experiment  lasting  several  days  was  3,248.3  grams  and  oxygen  con- 
sumed 2,755.3  grams. 

The  values  of  the  respiratory  quotient,  i.e.,  the  proportion  of  the  Og 
intake  to  the  O2  output  in  the  form  of  COg — 

Gram  Oo  in  COo         c.c.  COo 


'2^"   vyw2 


Gram  Oo  c.c.  Og 

on  a  fat  and  carbohydrate  dietary  can  easily  be  calculated  from  the  ele- 
mentary composition  of  these  food  principles. 
According  to  von  Noorden(8)  : 

In  the  case  of  these  two  foodstuffs,  decomposition  products  of  different  ele- 
mentary composition,  which  would  require  to  be  taken  into  consideration,  do  not, 
as  a  rule,  appear  either  in  the  urine  or  in  the  feces  in  appreciable  quantities.  It 
is  quite  different  in  the  case  of  protein,  where  the  amounts  of  C,  H,  O,  and  S  ap- 
pearing in  the  urine  and  feces  must  be  deducted  in  order  to  ascertain  the  quan- 
tity of  oxygen  required  for  the  formation  of  H^O  and  COg.  As  its  amount  varies 
in  different  experiments,  and  as  the  nature  of  the  calculations  differs  not  only  for 
different  proteins,  but  also  as  carried  out  by  different  authors,  so  the  statements 
vary  as  to  the  amount  of  oxygen  requisite  for  the  combustion  of  the  protein,  and 
also  as  to  the  amount  of  CO,  expired.  For  these  reasons  the  respiratory  quotient, 
as  well  as  the  physiological  and  physical  heat  values,  vary  in  the  ease  of  a  protein 
dietary. 

The  amount  of  the  respiratory  quotient  for  the  most  common  sub- 
stances, according  to  von  Noorden,  is  as  follows: 

Starch,  etc 1 .00 

Fat • 0.707 

Protein 0.809 

Alcohol 0.667 

"The  calculated  theoretical  limiting  values  of  the  respiratory  quotient, 
in  the  case  of  the  exclusive  combustion  of  the  carbohydrates,  or  of  fats, 
are  usually  not  attained  within  the  organism,  since  protein  is  invariably 
oxidized  along  with  these  bodies.  If  we  take  for  the  fasting  state  (the 
individual  being  in  fair  average  condition)  the  proportion  on  the  part  of 
the  protein  in  the  total  energy  exchange  of  the  organism  as  15  per  cent 


FACTORS    WHICH    AFFECT    METABOLISM  295 

of  the  latter,  then  the  limiting  values  of  the  respiratory  quotient,  with  a 
distribution  of  the  energy  exchange,  are  as  follows : 

With  15  per  cent  (energy  value)  protein,  85  per  cent  (energy  value) 

carbohydrate  =  0.971  respiratory  quotient. 
With  15  per  cent  (energy  value)  protein,  85  per  cent  (energy  value) 
fat  =  0.722  respiratory  quotient. 

"Under  normal  nutritive  conditions  these  values  neither  rise  above  this 
level  nor  fall  below  it,  provided  that  the  oxidation  of  the  foodstuffs  to 
their  end-products  is  complete,  and  that  no  intermediate  products  appear." 

If  the  experimental  technic  be  correct,  and  the  analysis  accurate,  the 
height  of  the  respiratory  quotient  gives  us  an  idea  as  to  the  nature  of  the 
matter  which  has  undergone  metabolism  in  the  organism.  The  course  of 
the  respiratory  quotient  has  thus  given  definite  information  as  to  the 
rapidity  with  which  carbohydrate  and  other  food  materials  introduced 
into  the  body  have  undergone  metabolism (9).  The  respiratory  quotient 
is  always  increased  after  a  hearty  meal.  All  foodstuffs  rich  in  carbon 
augment  the  outgo  of  carbon  dioxid. 

According  to  William  Tibbies (1),  "A  strictly  carbohydrate  diet  is 
possible  only  for  short  periods  during  which  the  respiratory  quotient  rises 
to  unity  or  nearly  so."  A  dietary  consisting  largely  of  fat  lowers  the 
respiratory  quotient,  but  increases  the  expenditure  of  carbon  dioxid, 
while,  on  the  other  hand,  alcohol  and  the  ethereal  oils  diminish  the  outgo 
of  carbon  dioxid.  Again  the  respiratory  quotient  falls  in  the  formation 
of  sugar  from  protein,  for  which  considerable  oxygen  intake  is  necessary 
without  corresponding  quantities  of  carbon  dioxid  being  expired,  if  the 
glucose  formed  is  either  stored  as  glycogen  or  excreted  in  the  urine.  "Rest 
causes  a  fall  in  the  respiratory  quotient  to  about  0.7  or  0 . 8,  but  muscular 
activity  causes  an  increase  in  the  intake  of  oxygen  and  the  output  of 
carbon  dioxid,  especially  the  latter,  and  the  respiratory  quotient  rises  to 
0.8  to  0.9." 

FACTORS  WHICH  AFFECT  METABOLISM 

According  to  Sherman  (10) : 

The  calorimetric  method  of  studying  total  metabolism  permits  of  experiments 
being  carried  out  very  quickly,  and  is  therefore  especially  useful  for  the  direct 
investigation  of  conditions  -which  affect  metabolism  at  once,  e.g.,  muscular  work, 
work  of  digestion,  etc.  Moreover,  the  apparatus  can  be  made  portable  and  thuD 
be  carried  by  the  subject  like  a  knapsack  in  experiments  on  marching,  mountain 
climbing,  or  bicycling.  The  observations  cannot  be  made  continuous,  but  the 
probable  results  for  the  24  hours'  metabolism  can  be  estimated  by  the  data  ob- 
tained during  frequent  short  periods  at  different  times  of  the  day  and  night. 


296 


:nutrition  and  mineral  metabolism 


Assuming  that  the  total  nitrogen  and  carbon  of  the  absorbed  food  existed  in 
the  form  of  protein,  fat  and  carbohydrates,  and  that  the  amount  of  carbohydrates 
in  the  body  is  constant  from  day  to  day,  it  is  only  necessary  to  determine  the  car- 
bon dioxid  of  the  expired  air  and  the  carbon  and  nitrogen  of  the  waste  products 
in  order  to  calculate  the  amounts  of  material  oxidized  and  of  energy  liberated  in 
the  body.  Experiments  of  this  sort  have  played  a  most  important  part  in  the  de- 
velopment of  our  knowledge  of  nutrition.  The  calculations  are  usually  based  on 
the  following  average  analyses  of  protein  and  body  fat: 


Carbon.  . 
Nitrogen. 
Hydrogen 
Oxygen. . 
Sulphur. . 


Protein 


53 
16 

7 
23 

1 


100 


Fat 


76.5 

12 
11.5 


100 


The  following  table  shows  the  income  and  outgo  of  nitrogen  and  car- 
bon and  was  obtained  by  Atwater  in  one  of  his  respiration  experiments, 
from  a  man  on  ordinary  mixed  diet: 

CALCULATION   OF  ENERGY   METABOLISM  FROM   CARBON  AND 
NITROGEN  BALANCE.     MAN  OF  64  KILOGRAMS  AT  REST 
IN  ATWATER  RESPIRATION  APPARATUS 


Income:  Grams  per  Day 

Protein 

Fat 

Carbo- 
hydrate 

Nitrogen 

Carbon 

Total  in  food 

94.4 
5.4 

82.5 
3.7 

289.8 
3.2 

15.1 
0.9 

239.0 

Lost  in  digestion 

7.4 

Absorbed 

89.0 

78.8 

286.6 

14.2 

231.6 

Outgo 

By  lungs 

16.2 

207.3 

By  kidneys 

12.2 

Metabolized 

16.2 
-2.0 

219.5 

Balance 

-1-12.1 

The  above  experiment  shows  a  loss  of  2 , 0  grams  of  body  nitrogen  phis 
the  factor  x  6.25  equals  12.5  grams  of  body  nitrogen  consumed.  The  in- 
take of  nitrogen  was  89.0  grams  from  foodstuffs  absorbed,  and  in  all  there 


FACTORS    WHICH    AFFECT    METABOLISM  297 

were  burned  101.5  grams  of  protein.  The  respiratory  quotient  in  this 
experiment  at  the  commencement  of  each  experiment  day  was  in  equili- 
brium, therefore  the  conclusion  is  drawn  that  the  amount  of  carlwhydrate 
burned  equaled  the  intake  of  286.6  grams  per  day.  Therefore,  after  mak- 
ing due  allowance  from  this  balance  sheet  of  the  carbon  balance,  Sher- 
man (10)  estimates  the  amount  of  fat  burned  was  as  follows; 

SHERMAN'S  ESTIMATES  OF  ATWATER'S  EXPERIMENT 

12.5  grams  body  protein  yield  (12.5  x  53  per  cent) .  .     6.6  grams  carbon 

And  there  were  in  the  absorbed  food 231.6      "  " 

.-.  Total  available  was 238.2      « 

But  total  catabolized  was  only 219.5      "  " 

.-.  The  body  stored  in  the  form  of  fat 18.7      " 

Since  fat  contains  76.5  per  cent  carbon,  1  gram  carbon  ==  1.307  grams 
fat.    .  • .  18.7  grams  carbon  =  24.4  grams  fat. 

The  body  therefore  absorbed 78.8  grams  fat 

stored 24.4      «        " 

burned 54.4      «        " 

In  all,  the  body  burned  per  day: 

101.5  grams  protein,  yielding (101.5  x  4.35') 442  calories 

54.4      "      fat,  "      (54.4x9.450 515 

286.6  «      carbohydrate,        «       (286.6  x  4.1  ») 1,175 


Total 2,132  calories 

Consumption  of  Food — Many  suggestions  have  been  advanced  in 
explanation  of  the  increased  metabolism  following  the  consumption  of 
food.  Mangus  Levy  (11),  Zuntz  and  others  think  the  increase  due  to 
intestinal  and  glandular  work,  that  is,  to  the  expenditure  required  for  the 
enlarged  demands  upon  the  muscular  system,  and  for  the  work  of  secre- 
tion carried  out  by  the  numerous  glands  present  in  the  alimentary  canal. 
Kubner(12)  assumes,  in  addition  to  the  glandular  work  proper,  a  specific 
action  on  metabolism  is  produced  by  the  excess  of  protein.  He  holds  that 
every  foodstuff  possesses  a  "specific  dynamic"  action.  He  also  believes 
that  the  protein  molecule  is  decomposed  in  all  cases  into  a  nitrogenous  com- 
ponent and  a  non-nitrogenous  component  of  a  carbohydrate  nature. 

You"  !Noorden(8)  recognizes  a  specific  action  of  protein  nutriment 
without  adapting  Rubner's  explanation.  He  asserts  that  the  increased  oxi- 
dation occurring  after  the  consumption  of  fats  and  carbohydrates,  as  well 
as  that  following  the  ingestion  of  protein,  is  due  in  the  main  to  intestinal 
and  glandular  work. 


1  Here  the  factors  for  fuel  value  are  not  reduced  to  allow  for  loss  in  digestion, 
because  this  loss  has  already  been  deducted  in  computing  the  amount  of  each  nutrient 
actually  absorbed  and  rendered  available. 


298 


NUTRITION  AND  MINERAL  METABOLISM 


Fasting. — The  effect  of  fasting  on  metabolism  has  been  studied  in 
great  detail  by  Atwater  and  Benedict  (13),  who  were  able  to  determine 
by  means  of  the  respiration  calorimeter  the  heat  production  of  the  same 
(control)  man  during  five-day  fasting  experiments  of  one  or  two  days 
each,  and  during  a  four-day  experiment  with  food  about  sufficient  for 
equilibrium  maintenance.  They  found  a  total  metabolism  on  fasting  days 
to  be  9  per  cent  lower  than  on  the  days  when  food  was  taken.  Later, 
Benedict (14)  found,  after  an  extensive  research,  that  if  the  fast  was  suf- 
ficiently prolonged,  there  would  be  a  decrease  in  heat  production.  He 
conducted  an  experiment  on  a  man  during  a  seven  days'  fast,  "while 
the  man  was  living  on  his  own  flesh  and  fat,"  and  found  the  loss  to  be : 
protein,  69.5;  fat,  139.6;  glycogen,  23  grams  per  day;  total,  1,597 
calories.  The  protein  loss  equaled  347  grams  of  flesh ;  the  actual  loss  of 
energy  measured  by  the  calorimeter  was  1.696  per  diem,  or  100  grams 
more  than  the  estimated  cost.  The  heat  of  combustion  can  be  arrived  at 
from  the  known  caloric  value  of  the  substances ;  for  example,  1  gram  of 
body  protein  yields  5.65  calories,  and  1  gram  of  fat,  9.54  calories,  and  the 
total  when  fully  oxidized  in  the  human  economy  would  aggregate  1.734 
.  calories. 

The  Swedish  investigator  Tigerstedt  made  a  careful  study  of  the  car- 
bon and  nitrogen  balance,  the  metabolism  of  a  man  who  abstained  from 
food  for  five  days,  following  this  period  with  a  liberal  diet  for  the  next 
two  weeks.  The  production  of  heat  during  the  first  two  days  of  fasting 
could  not  be  as  definitely  determined  as  in  the  last  three  days  because  of 
the  loss  of  an  unknown  quantity  of  glycogen  during  the  first  days. 

The  following  data  was  obtained,  which  we  take  from  Sherman  and 
append  below: 

METABOLIC   CARBON  AND  NITROGEN  BALANCE   DURING   FASTING 


Body  weight 
kilos 

Calculated  total 

metabolism, 

calories 

Calories 
per  kilo 

First     fast  day 

67.0 
65.7 
64.9 
64.0 
63.1 
64.0 
65.6 

2220^ 
2102^ 
2024 
1992 
1970 
2437 
2410 

32.21 

Second    "      "  

32.01 

Third      "      "  

31.2 

Fourth    "      «  

31.1 

Fifth       "      "  

31.2 

Fed  4141  calories 

38.1 

«    4141       «       (second day).. 

36.8 

1  These  figures  are  slightly  too  high,  because  the  loss  of  carbon  on  these  days  was 
due  in  part  to  combustion  of  glycogen,  but  is  calculated  as  if  duq  simply  to  protein 
and  fat. 


FACTORS    WHICH   AFFECT    METABOLISM  299 

These  tabulated  results  clearly  show  that  during  a  period  of  fasting 
the  metabolism  remains  fairly  constant,  notwithstanding  the  fact  that 
energy  is  generated  at  the  expense  of  the  tissues.  In  this  experiment 
4,141  calories  of  energy  were  produced  by  the  food  eaten — twice  the 
amount  that  would  have  been  necessary  for  mere  maintenance.  Conse- 
quently the  work  of  digestion  and  assimilation  was  doubled.  It  appears 
then  that  as  a  result  of  fasting  the  entire  metabolism  of  an  individual 
at  rest  remains  fairly  constant,  and  the  body  possesses  but  little  capacity 
for  the  adjustment  of  its  energy  metabolism  to  its  food  supply. 

Effect  of  Nitrogenous  Diet  on  Metabolism. — The  effect  of  nitrogenous 
diet  on  metabolism  has  been  studied  extensively  by  von  Noorden(8),  who 
holds  that  the  most  striking  effect  of  a  purely  nitrogenous  diet  is  a  large 
increase  in  the  nitrogenous  metabolism,  but  at  the  same  time  it  also 
increases  the  metabolism  of  the  non-nitrogenous  elements  of  the  body. 

As  the  amount  of  protein  ingested  is  increased,  a  rise  in  protein  metab- 
olism is  produced.  This  sequence  occurs  to  such  a  degree  that  nitrogen 
equilibrium  can  generally  be  maintained  on  the  most  varied  quantities 
of  protein,  which  goes  to  prove  that  the  body  is  not  able  to  store  up  any 
excess  of  protein.  At  first  glance,  the  fact  that  the  body  has  the  power  to 
break  down  as  much  protein  as  is  given  to  it  would  not  appear  to  be  in 
accordance  with  the  law  that  the  extent  of  protein  metabolism  is  governed 
by  the  tissue  requirements,  not  by  the  quantity  that  is  offered  to  the  cells. 
This  law  is  absolutely  true  so  far  as  the  consumption  of  oxygen-  and  nitro- 
gen-free substances  is  concerned.  Usually  when  there  is  an  increased 
consumption  in  protein,  there  is  also  a  lessened  consumption  of  other 
foodstuff's,  so  that  with  the  increased  proportion  of  protein  there  is  a  les- 
sened intake  of  other  material.  Thus  the  total  energy  metabolism  is 
raised,  to  proportionately  a  small  extent,  only  when  nitrogen-free  sub- 
stances are  replaced  simply  by  protein.  Perhaps  the  difficulty  of  explana- 
tion might  be  made  plainer  if  the  hypothesis  were  found  to  be  correct 
that  the  food  protein  is  actually  only  in  small  part  transformed  into  true 
protein  within  the  body,  or  that  it  plays  the  part  of  protein  within  the 
organism  only  to  a  small  extent. 

The  statement  that  the  body  can  consume  all  protein  ingested  within 
a  period  of  twenty-four  hours  exceeds  definite  knowledge  of  the  condi- 
tions. It  is  known  that  the  nitrogen  and  sulphur  are  eliminated  mthin 
this  period.  But  whether  the  carbon  that  is  eliminated  during  this  period 
is  derived  from  the  protein  or  from  other  sources,  and  if  from  the  latter, 
whether  the  carbon  derived  from  the  protein  is  stored  up  in  any  special 
form  in  the  body — these  are  problems  yet  to  be  solved. 


300        iv"utritio:n^  and  mineral  metabolism 

According  to  von  Noorden's  reasoning  it  is  probable  that  the  former  is 
correct,  because,  as  a  rule,  bodies  of  small  molecular  weight,  such  as  amino 
acids,  etc.,  are  completely  burned  up  as  soon  as  decomposition  and  oxida- 
tion have  once  commenced. 

In  order  to  learn  how  the  body  attempts  to  adapt  the  combustion  of 
protein  to  its  intake,  it  is  well  to  observe  conditions  in  instances  in  which 
different  amounts  of  protein  are  added  to  a  dietary  which  is  nearly  enough 
for  the  requirements  of  the  body.  If  the  increase  or  decrease  is  not  ex- 
treme, the  nitrogen  equilibrium  of  the  organism  will  not  be  reestablished 
for  several  days.  In  the  ordinary  daily  routine  when  the  intake  of  food 
varies  with  the  appetite  and  other  influences,  the  intake  and  elimination 
of  nitrogen  often  take  place  at  very  short  intervals,  and  so  in  general, 
nitrogen  equilibrium  is  kept  up  on  a  sufficient  diet  for  long  periods.  In 
many  instances,  individuals  during  hot  weather  or  when  in  tropical  re- 
gions cannot  take  enough  food  to  supply  the  needs  of  the  body,  and  in 
consequence  lose  both  protein  and  fat.  Von  Noorden(8)  proved  this  to 
be  true  by  experimenting  upon  himself.  He  determined  that  the  main- 
tenance of  weight  was  regulated  by  the  fact  that  the  amount  of  food  in- 
gested as  governed  by  the  appetite  meets  on  the  whole  the  definite  needs 
of  the  body.  In  prolonged  experiments  on  man  it  has  been  found  that 
nitrogenous  metabolism  is  not  by  any  means  as  uniformly  maintained  on 
an  unvaried  protein  and  caloric  intake  as  is  the  case  in  experiments  on 
dogs.  Kosemann  in  one  experiment  found  a  daily  variation  of  10  grams 
of  nitrogen.  He  points  to  temporary  retention  and  subsequent  washing 
out  of  the  end-products  of  nitrogenous  metabolism  as  accounting  for  these 
variations.    But  this  explanation  has  not  sufficient  foundation. 

Atwater  and  Benedict(15)  note  the  frequent  occurrence  of  similar 
irregularities.  In  one  of  their  experiments,  variations  in  nitrogen  elimi- 
nation on  a  constant  diet  were  17.2,  17.6,  14.2,  23.8,  20.3,  17.4,  17.2  and 
17.4  grams.  Psychical  conditions  were  cited  as  the  cause  of  these  varia- 
tions. The  individual  in  question  was  so  anxious  about  going  into  the 
•respiration  calorimeter  chamber  that  the  mental  disturbance  brought  about 
a  rise  in  protein  metabolism.  If,  as  sometimes  happens  on  the  last  day 
of  an  experiment,  protein  metabolism  is  strongly  influenced  by  certain 
external  conditions,  the  result  of  the  entire  series  is  apt  to  be  markedly 
affected.     This  result  is  naturally  exaggerated  in  shorter  series. 

Carbohydrates  as  Protein  Sparers — Carbohydrates  as  protein  sparers 
have  of  late  received  marked  attention  by  research  workers  on  metabolism. 
It  has  been  observed  that,  where  there  is  a  deficiency  of  protein  in  the  food 
supply,  the  metabolism  of  nitrogen  will  be  spared  and  the  tissues  pro- 


FACTORS    WHICH    xVFFECT    METABOLISM  301 

tected  if  the  food  contains  a  liberal  allowance  of  carbohydrate  and  fat. 
Liisk(lO)  has  fully  investigated  this  subject,  and  found  that,  when  the 
aliment  contained  an  abundance  of  protein,  fat  and  carbohydrate,  the 
organism  would  gain  a  little  nitrogen ;  when  the  ration  contained  tlie  same 
amount  of  protein,  hut  no  carbohydrate,  the  body  lost  nitrogen.  On  the 
other  hand,  when  the  ordinary  dietary  contained  only  a  sufficiency  of 
energy,  but  was  of  a  low  protein  content,  the  excretion  of  nitrogen  was 
normal.  Lusk,  therefore,  concluded  that  carbohydrate  acted  as  a  sparer 
of  protein. 

The  protein-sparing  action  of  carbohydrates  is  now  well  known  (edi- 
torial, Jour.  A.  M.  A.,  1917),  and  they  are  by  far  more  efficient  protein- 
sparers  than  fats.  "The  starvation  output  of  nitrogenous  waste  products, 
especially  urea,  can  be  materially  lessened  by  the  ingestion  of  either  fats 
or  carbohydrates,  though  the  superiority  of  the  latter  non-nitrogenous 
foodstuffs  in  lessening  nitrogen  waste  is  always  greater.  If  the  carbo- 
hydrates are  omitted  from  the  dietary  or  even  replaced  by  fats,  the  effect 
on  the  amount  of  nitrogen  excreted  is  promptly  perceptible. 

"Various  theories  have  been  proposed  to  explain  this  unique  function 
of  the  carbohydrates  in  nutrition.  One  view  has  maintained  that  a  certain 
concentration  of  blood  sugar  is  always  necessary  for  proper  maintenance 
of  physiological  activities.  This  sugar  can  be  produced  from  proteins  if 
carbohydrates  are  not  directly  available,  and  since,  in  the  absence  of  car- 
bohydrates, under  physiologic  conditions,  fat  cannot  well  supply  this 
want,  proteins  are  broken  down  to  yield  the  sugar  that  is  lacking.  The 
result  is  an  increase  in  the  nitrogen  output  in  carbohydrate  starvation." 

Another  view  lately  championed  by  Cathcart(17),  of  Glasgow,  and 
Janney(18),  of  New  York,  postulates  that  carbohydrate  is  essential  to 
protein  synthesis.  "There  is  no  doubt  at  present  that  sugar  is  not  oxi- 
dized directly  in  the  metabolism  of  the  organism,  but  is  rather  dissociated 
in  a  definite  way  into  simpler  derivations,  of  which  methyl  glyoxal, 
CH.3CH.CHO,  lactic  acid,  CH3CHOH.COOH,  and  pyruvic  acid, 
CH3CO.COOII,  are  the  most  interesting  possibilities.  There  is  evi- 
dence that  these  compounds  derived  from  sugars  can  in  turn  be  converted 
into  sugar  in  the  diabetic  individual.  They  may,  accordingly,  be  con- 
cerned in  the  synthesis  as  well  as  the  disintegration  of  the  sugar  molecule. 
But  there  is  also  some  evidence  now  available,  largely  from  perfusion 
experiments  on  surviving  isolated  organs,  that  both  pyruvic  and  lactic 
acids  can  be  converted  into  the  amino-acid  alanin ;  that  is,  they  can  add 
nitrogen  under  conditions  approximating  physiologic  possibilities." 

Kocher(19)  has  recently  reminded  us  that,  if  this  process  of  retaining 


302  NUTRITION  AND  MINERAL  METABOLISM 

nitrogen  by  dissociation  products  of  sugar  to  form  new  amino-acids,  and 
hence  proteins,  occurs  on  a  large  scale  in  the  body,  it  will  explain  why 
ingestion  of  carbohydrates  spares  body  protein.  To  test  this  point,  he  has 
undertaken  a  comparison  of  the  sparing  effects  of  ingesting  lactic  and 
pyruvic  acids  in  contrast  with  equivalent  amounts  of  undissociated  carbo- 
hydrates, like  sucrose,  on  the  nitrogen  output.  The  outcome  of  these  ex- 
periments, conducted  at  the  George  W.  Hooper  Foundation  for  Medical 
Research  of  the  University  of  California  (Jour.  A.  M.  A.,  1917),  indi- 
cates that  lactic  acid  exerts  practically  the  same  sparing  action  on  protein 
metabolism  as  do  carbohydrates.  "The  sparing  action  of  pyruvic  acid  also 
is  very  distinct,  but  less  marked  than  that  following  sugar.  In  view  of 
what  has  already  been  mentioned  regarding  the  possibility  of  adding  am- 
monia to  the  structures  of  the  sugar  derivatives  to  form  alanin,  it  is  readily 
conceivable  that,  when  this  process  is  operative,  nitrogen  arising  from  the 
catabolism  of  body  proteins,  instead  of  being  promptly  excreted,  is  util- 
ized to  synthetize  new  protein.  This  is  not  a  new  conception  of  metab- 
olism ;  but  Kocher's  work  gives  added  support  to  the  possibility  that  the 
fixing  of  catabolized  nitrogen  by  the  dissociation  products  of  glucose  to 
form  new  proteins  is  the  true  mechanism  of  the  sparing  effects  of  feeding 
carbohydrates  on  the  nitrogen  output." 

Fat  versus  Carbohydrates  as  Protein  Sparers — The  subject  of  fats  versus 
carbohydrates  as  protein  sparers  has  been  studied  exclusively  by  Kayser 
and  Landergren(20).  They  believe  that  fat  quite  as  well  as  the  carbo- 
hydrates protects  ])rotein  not  only  in  nitrogen  hunger  but  in  nitrogen 
abundance.  According  to  Landergrcn,  in  certain  instances,  fat  alone  as 
comj)ared  with  carbohydrates  seemed  to  exert  half  the  protective  power 
of  the  latter  as  a  protein  sparer.  This  he  attempted  to  substantiate  on 
the  ground  of  the  demand  of  the  body  for  carbohydrates ;  and  that  when 
deprived  of  this  food  element,  the  glycogen  formed  in  the  tissues  from 
protein  is  accepted  as  a  substitute  for  combustion.  The  role  of  protein 
in  this  process  cannot  be  taken  by  fat.  It  follows  that  as  soon  as  the  sup- 
ply of  glycogen  in  the  body  is  exhausted,  fat  has  less  protective  power 
than  carbohydrate  as  a  protein  sparer. 

Atwater(21)  concluded  from  his  experiments  that  the  total  available 
energy  remaining  uniform,  protein  protection  by  carbohydrates  (largely 
cane  sugar)  is  slightly  superior  to  an  isodynamic  amount  of  fat;  this  fact 
may  possibly  be  due  to  the  "personal  equation"  of  the  control. 

Kayser  (22),  in  a  series  of  experiments,  compared  the  efficiency  of  car- 
bohydrates and  fats  as  sparers  of  protein  by  carefully  determining  the 
nitrogen  balance  and  substituting  the  carbohydrates  of  the  ration  by  an 


FACTORS    WHICH    AFFECT    METABOLISM 


303 


amount  of  fat  vvhieli  woiiUl  furnish  the  same  fuel  value  in  calories.  The 
control  who  served  as  his  subject  for  this  experiment  was  a  man  23  years 
old,  of  good  physique,  weighing  67  kilograms,  with  a  small  store  of  body 
fat.  During  the  first  and  third  periods  of  observation,  his  alimentation 
consisted  of  meat,  rice,  butter,  eggs,  sugar,  oil,  vinegar  and  salad.  During 
the  second  period,  his  dietary  consisted  of  meat,  eggs,  oil,  vinegar  and 
salad,  all  of  the  carbohydrates  being  practically  withdrawn  and  replaced 
by -fat.  The  two  rations  had  practically,  the  same  fnel  value  and  protein 
percentages.    The  results  of  this  study  are  tabulated  below : 

KAYSER'S  TABLE   SHOWING   NITROGEN   BALANCE  WHEN  FEEDING 
ISODYNAMIC  QUANTITIES  OF  CARBOHYDRATE  AND  FAT 


Day 

Intake 

Output, 

Total 

Nitrogen 

Nitrogen 
Balance 

Total 
Nitrogen 

Fat 

Carbo- 
hydrates 

Fuel 
Value 

1 

Grams 
21.15 
21.15 
21.15 
21.31 
21.51 
21.55 
21.55 
21.10 
21.10 
21.10 

Grams 

71.1 

71.8 

71.8 

71.8 

221.1 

217.0 

215.5 

70.4 

70.4 

70.4 

Grams 
338.2 
338.2 
338.2 
338.2 

0 

0 

0 
338.2 
338.2 
338.2 

Grams 
2590 
2596 
2596 
2600 
2607 
2570 
2556 
2581 
2581 
2581 

Grams 
18.66 
20.04 
20.59 
21.31 
23.28 
24.03 
26.53 
21.65 
19.20 
19.65 

Grams 
2.46 

2 

1.11 

3 

0.56 

4 

0.00 

5 

6 

1.77 
2.48 

7 

4.98 

8 

0.55 

9 

10 

1.89 
1.45 

On  carefully  examining  this  table  it  will  be  seen  from  the  nitrogen 
balance  of  the  first  period  that  the  amount  of  protein  in  the  food  was  more 
abundant  than  was  necessary;  however,  the  nitrogen  equilibrium  was 
established  on  the  fourth  day.  When  fat  was  substituted  for  carbohy- 
drate, there  was  a  marked  increase  in  protein  catabolism  with  correspond- 
ing loss  of  nitrogen  from  the  body.  On  the  other  hand,  the  loss  of  nitrogen 
increased  daily  while  the  fat  diet  was  continued,  but,  upon  resuming 
the  mixed  diet,  not  only  was  the  loss  of  protein  stopped,  but  the  body  im- 
mediately began  replacing  the  protein  it  had  lost,  although  the  nitrogen 
and  the  calories  of  the  food  remained  practically  the  same. 

Kayser  found  that  "the  nitrogen  intake  remaining  constant,  the  sub- 
stitution of  isodynamic  amounts  of  fat  for  all  the  carbohydrates  of  the 
diet  resulted  within  three  days  in  a  total  loss  of  9.2  grams  of  nitrogen. 
The  loss  on  the  first  day  was  l.YY ;  on  the  second  day,  2.48 ;  and  on  the 
third  day,  4.98,  while  during  the  periods  before  and  after,  one  gram  of 


304 


NUTKITIOX  AXD  MIN^ERAL  METABOLISM 


iiiti-ogeii  daily  was  retained.  Landergi-en,  who  holds  that  the  variation, 
between  carbohydrates  and  fats  as  protein  sparers  is  not  dependent  upon 
the  difference  in  their  physical  and  chemical  properties,  advances  the 
following  explanation  as  a  possible  solution  of  the  problem.  If  there 
are  no  disposable  carbohydrates  present,  either  in  the  food  or  in  the 
storehouse  of  the  body,  then  the  organism  must  itself  produce  carbo- 
hydrate in  order  to  satisfy  its  requirements.  As,  according  to  this  investi- 
gator, a  formation  of  sugar  from  protein  may  take  place,  but  never  one 
from  fat  (at  least,  under  physiological  conditions),  then,  in  the  absence 
of  carbohydrate,  a  certain  additional  amount  of  protein  must  break  down, 
in  order  to  furnish  the  necessary  carbohydrate  requirements  of  the 
organism."  This  investigator  finds  the  absolute  daily  carbohydrate  re- 
quirement of  the  adult  to  be  40  to  50  grams.  In  his  opinion,  30  to  40 
grams  of  protein  will  be  sufficient  to  furnish  this  amount  if  no  preformed 
carbohydrates  are  present. 

Atwater(23),  in  one  of  his  researches,  compared  the  protein-sparing 
power  of  carbohydrate  and  fat  in  an  experiment  in  which  his  subject  was 
an  athletic  young  man  weighing  67  kilograms,  who  was  accustomed  to 
perform  a  considerable  amount  of  %vork.  The  fifteen-day  experiment  was 
conducted  in  the  respiration  calorimeter,  and  the  subsistence,  rich  in 
carbohydrates,  was  arranged  in  four  periods  which  were  alternated 
with  four  equal  periods  in  which  the  diet  was  rich  in  fat.  The  change 
from  carbohydrate  to  fat  and  vice  versa  involved  about  2,000  calories  or 
nearly  half  the  fuel  value  of  the  diet.  The  average  results  per  day  for  this 
experiment  were  tabulated  as  follows : 

SPARING  POWER  OF  CARBOHYDRATES  AND  FAT  IN  CALORIMETRIC 
EXPERIMENTS  (ATWATER) 


On  Diet  Rich  in 
Carbohvdrates 


On  Diet  Rich  in 
Fat 


Available  calories  in  food 

Heat  equivalent  of  work  performed,  calories . 
Nitrogen  in  food,  grams 

«  feces,      "     

"  urine,      "     

"        balance,      "     


4532 

558 

17.5 

2.5 

16.6 

-1.6 


4524 
554 
17.1 
1.7 

18.1 

-2.7 


The  difference  here  is  in  favor  of  the  carbohydrate,  but  this  is  so  small 
as  to  be  of  no  practical  significance. 

It  appears  that  the  carbohvdrates  of  the  dietary  cannot  be  entirely 


FACTORS    WHICH    AFFECT    METABOLISM  305 

replaced  by  an  equal  luniiber  of  calories  iu  the  form  of  fat  without  jeop- 
ardizing the  nitrogen  balance. 

Gelatin  as  a  Protein  Sparer — Gelatin  as  a  protein  sparer  has  been 
studied  extensively  by  Voit,  Wilcock,  Hopkins,  Kaiiffmann,  Kolpakcha 
and  others.  According  to  Voit  (24),  it  would  seem  that  the  high  nitrogen 
content  of  gelatin  and  the  fact  that  it  is  soluble  led  to  a  tendency  to 
attribute  to  it  an  unusual  nutritive  value.  The  fact,  too,  that  gelatin  could 
be  obtained  from  bones,  which  otherwise  were  burned  or  thrown  away, 
was  important  iu  suggesting  it  as  a  means  for  the  economical  feeding  of 
the  poor.  The  history  of  gelatin  as  a  food  is  very  interesting,  and  indeed 
instnu'tive,  since  it  serves  as  a  warning  against  a  premature  application 
of  the  results  of  scientific  investigation. 

A  committee  of  the  Paris  Academy  of  Medicine  investigated  gelatin 
as  a  food  and  recommended  it  as  a  most  nutritious  and  healthful  foodstuff 
when  its  natural  insipidity  was  corrected  by  the  addition  of  salts  and 
savory  herbs.  On  the  basis  of  this  report,  gelatin  was  generally  used  in 
the  nourishment  of  hospital  patients,  but  in  the  course  of  time,  complaints 
were  made  and  doubt  raised  as  to  its  real  food  value.  The  true  value  of 
gelatin  as  a  food,  as  we  understand  it  to-day,  was  established  by  Voit's 
experiments,  still  it  is  evident  that  something  remains  to  be  explained. 
It  is  not  clear  why  it  cannot  be  better  borne  in  a  diet  when  used  in  larger 
quantities.  Wilcock  and  Hopkins (25),  after  an  extended  study  of  this 
subject,  conclude  that  the  special  protein-sparing  properties  of  gelatin 
are  due  largely  to  the  abundance  of  glycocoU  in  its  composition,  and  aver 
that  it  shares  with  protein  certain  molecular  groupings  necessary  to  satisfy 
specific  needs  and  is  thus  superior  to  fats  and  carbohydrate  as  a  protein 
sparer.  It  lacks,  on  the  other  hand,  certain  necessary  groupings,  there- 
fore failing  to  supply  all  such  needs,  and  thus  cannot  replace  protein.  It 
is  a  well-known  fact  that  gelatin  as  a  sole  protein  food  does  not  suffice  for 
the  maintenance  of  nitrogen  equilibrium.  Recent  study  of  protein  chem- 
istry has  shown  that  gelatin  differs  from  most  other  proteins  in  yielding 
on  hydrolysis  no  tyrosin  nor  tryptophan  and  little  if  any  cystin. 

Kauffmann(2G)  personally  experimented  with  a  diet  in  which  these 
three  amino-acids  were  ingested  along  with  gelatin  to  the  exclusion  of 
other  protein,  and  found  that  nitrogen  equilibrium  was  maintained 
throughout  the  entire  five  days'  fast  on  this  aliment.  Von  !N'oorden(8), 
after  many  qualitative  analyses  of  gelatin,  is  certain  that  it  contains  much 
glycocoll  and  very  little  leucin  and  aromatic  amino-acids.  He  believes  the 
variable  composition  of  gelatin  is  but  one  of  the  reasons  why  it  is  so  ill 
adapted  for  the  building  up  of  protein.     He  arrives  at  this  conclusion 


306  NUTRITION  AND  MINERAL  METABOLISM 

after  an  experiment,  and  says  a  considerable  quantity  of  gelatin  in  the 
food  effects  the  economy  from  20  to  30  per  cent  in  the  protein  decomposi- 
tion of  starvation,  but  quantities  three  or  four  times  as  great  increase  the 
economy  to  only  40  per  cent  instead  of  trebling  or  quadrupling  it  as 
might  be  expected.  The  loss  of  body  protein  cannot  be  prevented  by  add- 
ing much  non-nitrogenous  food  to  even  the  largest  gelatin  diets.  A  few 
years  ago  there  was  prevalent  a  popular  idea  that  jelly  was  strengthening. 
Physicians  concluded  this  to  be  erroneous  and  averred  that  jelly  was  of 
no  use.  Both  were  wrong.  Gelatin  undergoes  catabolism,  being 
changed  into  urea,  and  is  a  protector  of  protein,  not  by  lessening  the 
amount  of  material  oxidized  in  the  same  way  as  carbohydrate  and  fat, 
but  by  being  directly  substituted  for  the  nitrogenous  elements  of  the  body. 
The  addition  of  gelatin  to  the  dietary  aids  in  establishing  nitrogenous 
equilibrium  on  a  smaller  amoimt  of  protein  than  when  gelatin  is  with- 
held, and  even  the  consumption  of  fat  is  lessened  by  the  allowance  of 
gelatin  in  the  aliment.  This  is  all  the  plainer  when  we  consider  that 
gelatin  in  the  process  of  catabolism  is  split  into  a  urea  moiety  and  a  fatty 
moiety,  like  proteins.  The  important  point  in  this  connection  is  that 
gelatin,  alone  or  with  carbohydrates  or  fats,  does  not  suffice  to  maintain 
the  nitrogen  equilibrium.  It  does  not  supply  the  nitrogenous  material 
requisite  for  the  repair  of  tissue.  This  deficiency  is  explained  by  the  fact 
that  in  the  composition  of  gelatin  certain  important  amino-acids  are  lack- 
ing— tryptophan,  tjTosin  and  cystin. 

Howell (27)  states  that  "if  a  dog  is  fed  upon  a  diet  in  which  the  nitrog- 
enous material  is  represented  only  by  the  split  products  of  a  gelatin 
hydrolysis,  he  will  show  a  nitrogen  loss.  If  the  above  named  amino-acids 
are  added,  particularly  the  tryptophan,  he  will  be  maintained  in  nitrogen 
equilibrium.  It  is  at  present  conceded  that  gelatin  takes  the  place  of 
stored  or  circulating  protein,  but  not  of  tissue  proteins,  and  therefore  it 
will  be  seen  that  it  does  not  serve  the  purpose  of  replacing  the  wear  and 
tear  of  tissue."  Nevertheless,  gelatin  is  a  more  valuable  foodstuff  than  it 
was  formerly  considered  to  be. 

Alcohol  as  a  Protein  Sparer — "Alcohol  as  a  protein  sparer  has  been  the 
subject  of  much  discussion  among  physiologists.  It  would  be  impossible 
to  summarize  the  evidence  on  each  side  of  the  question  here,  but,  in  brief, 
the  results  of  the  latest  and  most  trustworthy  researches  show  that  alcohol 
undoubtedly  possesses  a  limited  power  in  restricting  nitrogenous  waste." 
Alcohol  is  unquestionably  a  fat-sparer,  though  with  greater  difficulty  is 
it  able  to  spare  carbohydrate.  But  while  sparing  fat,  and  sometimes 
carbohydrates,  it  is  itself  consumed — yielding  heat  and  energy  to  the 


FACTOllS    WlllCn    AFFECT    METABOLISM  307 

body.  This  was  once  a  mooted  point  with  physiologists,  but  there  is  no 
longer  any  doubt  that  alcohol  is  a  food,  but  a  very  expensive  food.  Care- 
ful research  has  shown  that  the  complete  combustion  of  one  gram  of  alco- 
hol in  the  body  will  yield  7  calories  of  heat  energy;  so  that  131  grams  of 
alcohol  will  yield  as  much  fuel  to  the  body  as  100  grams  of  fat,  which 
means  that  one  ounce  of  alcohol  is  equal  in  energy  or  fuel  value  to  one 
ounce  of  butter  (80  per  cent  fat).  While  this  statement  is  a  recorded 
fact,  we  do  not  intend  to  convey  the  idea  that  we  hold  that  alcohol  is  as 
good  a  source  of  energy  in  the  diet  as  fat.  Quite  the  contrary  is  the  case, 
for,  as  we  have  already  seen  {see  Volume  I,  Chapter  XVI,  page  578),  by 
dilating  the  blood  vessels  alcohol  may  cause  ni,ore  heat  dissipation  than 
it  is  itself  capable  of  producing. 

Besides,  the  energy  which  alcohol  yields  is  very  quickly  dissipated, 
owing  to  the  rapid  oxidation  of  alcohol  in  the  body,  while  fat  produces 
energy  in  a  slower  and  more  equable  fashion. 

Hutchison (28)  thinks  that  larger  doses  of  alcohol  cause  a  general 
paralysis  of  cellular  activity^  so  great  that  heat  production  is  diminished 
and  heat  loss  increased,, with  the  final  result  of  great  lowering  of  the  body 
temperature.  If  it  be  granted,  for  sake  of  argument,  that  alcohol  is  oxi- 
dized in  the  tissues  with  the  liberation  of  energy,  any  value  which  it  may 
possess  in  virtue  of  such  metabolic  action  is  seriously  counterbalanced  by 
its  paralyzing  and  anesthetizing  action  on  cellular  activity.  This  causes 
the  cells,  for  the  time  being,  to  lose  their  power  of  breaking  down  those 
compounds,  such  as  fat,  which  it  has,  even  under  normal  conditions  of 
full  activity,  most  difficulty  in  handling.  Moreover,  this  dulling  of  the 
senses  and  inhibition  of  cellular  activity  is  quite  in  accord  with  our  present 
understanding  of  the  effects  of  other  cell  poisons;  and  this  knowledge 
should  be  accepted  as  Nature's  warning,  for,  as  experience  has  shown, 
the  consumption  of  alcohol  during  muscular  work  augments  rather  than 
delays  fatigue  (29). 

Furthermore,  aS  previously  stated,  it  is  believed  that  to  a  limited 
extent  alcohol  may  lessen  nitrogenous  waste;  however,  its  action  in  this 
respect  is  much  less  than  that  of  carbohydrates,  and  less  even  than  that  of 
fats,  and  in  addition  there  seems  to  exist  some  subtle  influence  of  conditions 
not  clearly  understood,  which  depend,  in  certain  instances  (at  least  to  some 
extent),  upon  personal  peculiarities  of  the  subject. 

Habit,  also,  undoubtedly  Is  an  important  factor(30),  as,  with  those 
who  are  accustomed  to  alcohol,  the  initial  loss  in  nitrogen  is  less  marked 
than  in  the  case  of  total  abstainers.  In  the  case  of  fever  patients  wha 
have  been  previously  accustomed  to  the  consumption  of  alcohol,  even  large 


308 


NUTRITIOI^  AND  MINEKAL  METABOLISM 


quantities  do  not  give  rise  to  nitrogen  losses.  Practically  all  physiologists 
agree  that  alcohol  spares  less  protein  than  do  carbohydrates  when  both  are 
given  in  isodynamic  quantities,  but  in  practical  therapeutics  this  is  really 
of  little  importance.  The  physician  does  not  desire  to  make  use  of  the 
protein-sparing  properties  of  alcohol,  but  instead  he  does  endeavor  by  its 
use  to  spare  the  fat  of  the  organism. 

In  the  experiments  of  Atwater  and  Benedict  (31)  it  was  found  that 
the  utilization  of  the  different  foodstuffs  was  not  affected  by  the  adminis- 
tration of  alcohol,  as  shown  in  the  following  table : 

UTILIZATION  OF    DIFFERENT    FOODSTUFFS   WITH    AND    WITHOUT 

ALCOHOL 


Protein 

Fat 

Carbohydrates 

Energy 

With  alcohol 

Without  alcohol .  .  . 

93.7 
92.6 

94.6 
94.6 

97.8 
97.9 

92.1      - 
9L8 

This  tabulation  shows  the  extent  to  which  the  food  material  was  metab- 
olized when  alcohol  was  administered. 

It  has  been  held  by  some  observers  that  the  administration  of  alcohol 
exerted  a  favorable  action  in  retarding  tissue  waste  which  accompanies 
prolonged  pyrexia,  but  unless  its  metabolic  action  is  very  different  in  fever 
from  its  action  under  normal  healthy  conditions,  and  there  seems  to  be 
little  affirmative  evidence,  we  are  not  justified  in  granting  it  any  such 
favorable  action. 

Finally,  in  summing  up  the  influence  of  alcohol  on  metabolism,  we 
are  safe  in  concluding  that  it  is  burnt  up  in  the  body,  sparing  fat  and  car- 
bohydrates, and,  to  a  very  limited  extent,  it  may  spare  protein,  but  the 
weight  of  evidence  is  against  the  conclusion  that  it  exerts  any  important 
action  tending  to  inhibit  nitrogenous  waste  (32). 

Metabolism  of  Water — The  metabolism  of  water  in  the  human  econ- 
omy has  been  worked  over  by  many  serious  investigators.  Bischoff,  Foster 
and  Hennenberg  held  that  the  "flushing"  of  the  system  with  water 
hastened  the  breaking  down  of  protein  substances.  Voit(24),  in  particu- 
lar, was  the  first  to  make  any  trustworthy  experiments  upon  this  question. 
He  found  that  the  rise  in  the  excretion  of  nitrogen  was  25  per  cent,  with 
an  increase  of  the  total  urinary  sulphur  compounds  from  the  tissues,  and 
in  any  case  it  falls  far  short  of  the  amount  of  the  increase  of  the  nitrogen 
excretion  (33). 

Bidder,  Schmidt,  Murck  and  Meyer (34),  on  the  other  hand,  believe 
that  the  urinary  nitrogen  increases  because  the  tissues  are  more  thor- 


FACTORS    WHICH   AFFECT    METABOLISM 


309 


oughly  flushed  or  washed  out  and  thereby  lose  their  nitrogenous  end- 
products. 

The  human  body  consists  of  630  parts  per  1,000  of  water,  and  it  is  of 
the  greatest  importance  as  a  component  of  the  tissues  to  assist  in  the 
exchange  of  nutritive  substances,  the  discharge  of  the  products  of  metab- 
olism, the  regulation  of  temperature  and  other  vital  functions.  If  the 
supply  of  water  be  cut  off,  the  body  will  die,  and  it  will  succumb  sooner 
from  deprivation  of  water  than  by  starvation.  A  restriction  of  the  water 
supply  consumed  hastens  the  decomposition  of  protein  and  fat  to  replace 
the  water  essential  for  the  body  functions. 

Atwater  and  Benedict,  as  a  result  of  a  49-day  experiment  with  a 
control  in  repose,  showed  that  the"  average  income  of  water  was  2,290  c.c. 
and  the  excretion  3,700  c.c,  so  that  at  the  lowest  estimate  about  250  e.c. 
of  water  was  formed  in  the  tissues  by  the  oxidation  of  hydrogen  in  the 
food,  while  in  the  tissues  and  during  ordinary  work  they  found  that  from 
510  c.c.  to  540  c.c.  of  water  was  excreted  daily  in  excess  of  the  amount 
consumed  in  the  food  and  drink.  The  amount  of  water  ingested  with 
food  and  drink  varies  according  to  position,  life,  habits  and  environments 
of  the  individual,  but  the  above  figures  give  a  fair  idea  of  the  amounts  of 
water  taken  with  a  mixed   diet  under  comfortable  circumstances(17). 

Von  Noorden  holds  that,  in  addition  to  the  fluid  drunk,  the  body  has 
at  its  disposal  the  "oxidation  water,"  resulting  from  the  combustion  of 
the  hydrogen  of  the  food.  The  amount  of  this  varies  but  little,  depending 
less  upon  the  nature  of  the  food  oxidized  than  upon  its  quantity,  in 
other  words,  upon  the  absolute  extent  of  metabolism. 

The  following  table  graphically  emphasizes  this  point : 


"OXIDATION    WATER"    RESULTING    FROM    THE    COMBUSTION    OF 
HYDROGEN  IN  THE  FOOD 


Foods 

Contains 
grams  H 

Contains 
grams  H2O 

Yields 
calories 

100  calories 
3delds  grams  H2O 

100  grams  fat 

11.9 
6.78 
4.59 

13.4 

107.1 
55.5 
41.3 

117.4 

9,461 
4,181 
4,442 
6,981 

11.31 
13.3  \  11.3 
9.3  J 
16.6 

100      "      starch 

100      «      protein 

100      «      alcohol 

A  careful  study  of  the  above  tabulation  shows  that,  for  each  100 
calories  developed,  the  ternary  food  elements  produce  approximately  the 
same  amounts  of  water,  11.3  grams.  On  a  mixed  dietary,  where  fifty 
per  cent  of  the  potential  energy  is  derived  from  the  carbohydrates  and 

120 


310 


NUTRITIOK  AND  MINERAL  METABOLISM 


one-sixth  from  the  protein,  and  the  remaining  from  the  fat,  each  100 
calories  correspond  to  about  12  grams  of  water,  so  that  we  have: 


From. 
About. 


2,000       2,500       3,000       4,000  calories 
240  300  360  420  "oxidation"  water 


The  approximate  figures  from  von  Noorden,  just  given,  agree  fairly 
well  with  the  quantities  determined  experimentally  by  Voit,  which  were 
as  follows: 

During  starvation 32  gm.  H  equals  288  H2O,  with  an  exchange  of  about 

2,300  calories. 
With  average  diet  and  lightUO  gm.  H.  equals  360  H2O,  with  an  exchange  of  about 

work j         2,600  to  2,800  calories. 

With  hard  work 52  gm.  H.  equals  468  H2O,  with  an  exchange  of  about 

3,600  calories. 

Atwater  and  Benedict (35)  observed  that: 

During  rest 30  gm,  H  equals  270  H2O,  with  an  exchange  of  about 

2,209  calories. 
During  hard  work 50  gm.  H  equals  451  H2O,  \vith  an  exchange  of  about 

3,630  calories. 

Neumann(36)  conducted  an  ideal  experiment  upon  himself,  subsist- 
ing upon  a  regular  and  constant  dietary,  the  chief  results  of  which  are 
tabulated  below : 

NEUMANN'S  DIETARY  EXPERIMENT 


H20in 
drinks 

Nitrogen  Balance 

Total 
for 

Day 

1st 

2nd 

3rd 

4th 

5th       6th 

7th 

8th 

9th 

Entire 
Period 

1 

970 
3,000-3,900 

600-    900 
3,100-3,700 

700-1,700 

+0.42 

-3.8 

+3.35 

-3.16 

+2.91 

+0.19 
-2.4 
+  1.92 
-1.51 

+0.72 

+0.16 

-0.1 

+0.78 

+0.59 

+0.42 

-0.06 

+0.4 

? 

-6.3 

3 

+6.1 

4 
5 

+0.51 

+0.88 

-0.23 

+0.19 

+0.59 

+1.0 

+1.23 

-0.89 
4.9 

In  studying  this  table  it  will  be  seen  that  his  consumption  of  water 
increased  from  970  c,c.  the  first  day  of  first  period  to  3,900  c.c.  the  last 
day  of  the  second  period  and  3,700  c.c.  the  last  day  of  the  fourth  period. 

The  urinary  nitrogen  was  increased  during  only  the  first  two  days. 
On  and  after  the  fourth  day  he  remained  in  nitrogenous  equilibrium, 
although  he  continued  to  drink  abnormally  large  quantities  of  water.  Dur- 
ing this  experiment  Neumann  was  punctiliously  careful  as  to  details  and 
noted  when  he  returned  to  the  small  consumption  of  water,  as  in  the  third 
period,  or  after  he  had  flushed  out  his  system  for  a  long  period,  as  in  the 
fourth  period,  that  his  initial  loss  of  nitrogen  was  fully  compensated  by 
the  retention  of  corresponding  amounts  of  nitrogenous  substances. 


FACTORS  WHICH  AFFECT  METABOLISM     311 

Von  JS^oorden,  iu  commenting  upon  this  experiment,  emphasizes  the 
facts  as  tabiihited,  and  says :  "For  the  adult  healthy  man  the  question  has 
been  answered  once  for  all."  It  will  be  seen,  therefore,  that  "flushing 
out"  the  system  removes  the  end-products  of  nitrogenous  metabolism  with- 
out any  abnormal  breaking  up  of  protein. 

In  summing  up  the  results-  of  Neumann's  experiment,  von  Noorden 
concludes  as  follows : 

The  amount  first  washed  out  and  then  retained  was  about  six  grams  of  nitro- 
gen. One  might  be  tempted  to  regard  this  quantity  as  the  maximum  "excess  of 
extractives  loosely  retained  in  the  system,"  and  to  base  other  calculations  upon  it 
as  such  in  other  investigations  of  the  metabolism.  Were  this  justifiable,  one  would 
be  able  to  set  down  any  further  excess  of  nitrogen  lost  with  some  certainty  to  the 
decomposition  of  protein.  But  this  view  is  not  justifiable,  since  such  consumption 
of  water  produces  no  more  than  a  mechanical  flushing  of  the  tissues.  Under  dif- 
ferent circumstances,  it  is  quite  possible  that  perliaps  amounts  of  extractives 
might  leave  the  tissues;  yet  it  is  most  important  that  conclusions  drawn  from  the 
action  of  the  healthy  body  should  not  be  applied  to  diseased  tissues.  And  there  is 
one  thing  that  these  experiments  bring  out  very  clearly,  and  that  is  the  tenacity 
with  which  the  organism  holds  on  to  its  extractives.  With  but  few  exceptions, 
these  bodies  should  not  be  regarded  as  the  valueless  decomposition  products  des- 
tined for  excretion  only.  They  must  rather  have  definite  functions — of  which  we 
know  nothing  for  the  most  part — to  perform  in  the  economy  of  the  body. 

Metabolism  of  Mineral  Substances — The  metabolism  of  mineral  sub- 
stances, from  a  strictly  chemical  viewpoint,  is  of  small  moment,  since 
they  undergo  only  minor  chemical  changes,  and  play  even  a  less  important 
role  in  the  transformation  of  energy ;  they  are  not  sources  of  energy  and 
it  is  questionable  even  if  they  have  any  part  in  its  development.  Indeed, 
their  exact  significance  in  the  organism  is  only  partially  understood,  but  at 
the  same  time  it  is  a  well-known  physiological  fact  that  life  cannot  be  sup- 
ported on  foods  deficient  in  inorganic  salts.  Beyond  question  they  serve 
most  important  functions  in  maintaining  a  normal  composition  and 
osmotic  pressure  in  the  fluids  of  the  body,  and,  by  virtue  of  their  osmotic 
pressure,  they  play  an  important  part  in  the  ingress  and  egress  of  water 
to  and  from  the  tissues.  Besides,  the  inorganic  salts  constitute  an  essen- 
tial part  of  the  composition  of  all  living  matter. 

Howell  says: 

In  some  way  they  are  bound  up  in  the  structure  of  the  living  molecule  and  are 
necessary  to  its  normal  reactions  or  irritability.  Even  the  proteins  of  the  body 
liquids  contain  definite  amounts  of  ash,  and  if  this  ash  is  removed,  their  properties 
are  seriously  altered,  as  is  shown  by  the  fact  that  ash-free  native  proteins  lose 
their  property  of  coagulation  by  heat.    The  globulins  are  precipitated  from  their 


312 


NUTEITION  AliTD  MINERAL  METABOLISM 


solutions  when  the  salts  are  removed.  The  special  importance  of  the  calcium  salts 
in  the  coagulation  of  blood  and  the  curdling  of  milk  has  been  referred  to,  as  also 
the  peculiar  part  played  by  the  calcium,  potassium  and  sodium  salts  in  the 
rhythmical  contractions  of  heart  muscle,  the  irritability  of  muscular  and  nervous 
tissues,  and  the  permeability  of  the  capillary  wall  and  other  membranes.  The  spe- 
cial importance  of  the  iron  salts  for  the  production  of  hemoglobin  is  also  evident 
without  comment.  There  can  be  no  doubt,  in. fact,  that  each  one  of  the  salts  of 
the  body  has  a  special  nutritive  value  and  a  special  metabolic  history.  The  time 
will  doubtless  come  when  the  special  importance  of  the  potassium,  sodium,  cal- 
cium and  magnesium  will  be  understood  as  well,  at  least,  as  we  now  understand  the 
significance  of  iron,  and  quite  possibly  this  knowledge  will  find  a  direct  therapeutic 
application,  as  in  the  case  of  iron. 

In  the  human  body  the  mineral  salts  exist  partly  in  combination 
with  organic  substances  and  partly  in  solution  in  the  body  fluids.  In- 
organic substances,  when  burned  with  access  of  air,  set  free  the  mineral 
substances  which  exist  therein;  likewise,  when  foodstuffs  containing  the 
inorganic  salts  are  metabolized  in  the  body,  they  are  (with  the  exception 
of  iron)  given  off  chiefly  in  the  form  of  mineral  matter.  These  elements 
and  their  compounds  are  therefore  usually  referred  to  as  ash  constituents, 
and  their  metabolism  as  mineral  metabolism, 

The  table  given  below  shows  the  most  important  of  the  inorganic 
salts  and  the  percentage  found  in  bone,  muscle  and  the  various  organs  of 
the  body.  The  inorganic  salts  found  in  the  body  are  either  eliminated 
from  the  body  by  the  urine  and  other  excretions,  or  they  may  be  retained 
and  recombined  with  freshly  absorbed  organic  substances  from  the  ali- 
mentary canal. 

THE    PERCENTAGE    OF    ASH    IN    BONES,   MUSCLES,   AND    VARIOUS 

ORGANS 


g.a 

^-H      (V) 

Is 

Liver 
(Oidt- 
mann) 

Spleen 
(Oidt- 
mann) 

^    Si 

if 

Lymph 
(Dahn- 
hardt) 

Milk 
(Wilder- 
stein) 

Sodiiun  chlorid .  . 
Potassium  chlorid 
Soda 

10.59 

'2!35 

34.40 

1.99 

1.45 

48!  13 
"!81 

14.53 

25.23 

3.61 

.20 

2.74 

2.58 

so!  18 
.92 

"!27 

44.33 
9.60 

7.48 
.49 

7.28 
.54 

27!  10 

2.54 
' '  !l7 

4.74 

io!69 

34.42 

.72 

1.23 

56!  18 
.92 

■'!27 

58.81 

'4!  15 

11.97 
1.76 
1.12 

8.37 

io!23 

1.67 
1.19 

74.48 

10.35 
3.25 

.97 
.26 
.05 

"im 

'8!26 
.42 

10.73 
26.33 

Potash 

21.44 

Lime 

37.58 
1.22 

'L66 
53.31 

'  5!47 

18.78 

Magnesia 

Ferric  oxid 

Chlorin 

Fluorin 

.87 
.10 

Phosphoric  acid. . 
Sulphuric  acid .  . . 
Carbonic  acid — 
Silicic  acid 

19.00 
2.64 

FACTORS    WHICH    AFFECT    METABOLISM  313 

Von  Noorden  says : 

Extract  experiments  have  proven,  once  for  all,  the  ind'^pensable  importance  of 
the  inorganic  salts  to  the  organism,  and  the  amounts  in  which  they  are  required 
during  growth  has  been  repeatedly  investigated,  while  only  a  few  serviceable  de- 
terminations have  been  made  upon  the  adult. 

It  is  kno^vll  that  the  body  takes  up  the  organic  foodstuffs  to  supply 
it  with  energy,  in  response  to  a  definite  demand.  The  inorganic  material 
in  the  food  is  on  a  different  plane ;  like  water,  it  is  absorbed  in  excess,  or, 
more  plainly  speaking,  in  quantities  far  surpassing  the  normal  physio- 
logical minimum.  The  requisite  amount  of  the  daily  decomposition  under 
definite  conditions  of  life  and  nutrition,  calculated  on  the  basis  of  the 
urinary  salts,  is  stated  by  von  Noorden(17)  in  the  following  approximate 
figures : 

Gram  Gram 

CI 6-8  NaoO 4-6 

P2O, 2-3.5  .  FeaOs Traces 

SO, 2-3.5  CaO 0.15-0.35 

K2O 2-3  MgO 0.2-0.3 

The  physiological  minimum  intake  of  inorganic  matter  has  not  been 
extensively  investigated.  Indeed,  its  determination  is  beset  with  difii- 
cullies,  since  the  same  differences  obtain  as  in  the  case  of  the  demand  for 
protein  and  water,  and  these  depend  upon  individuality,  personal  idio- 
syncrasies and  upon  variations  of  the  organic  constituents  of  the  dietary. 
It  is  diflicult,  therefore,  to  arrive  at  a  "physiological  optimum."  This 
much  is  certain,  a  marked  decrease  in  the  amount  of  mineral  salts  must 
take  place  before  any  impairment  of  mineral  metabolism  is  noticeable. 
At  any  rate,  no  scientific  proof  of  its  importance  is  available,  and  beyond 
question  there  is  an  absence  of  accurate  information  of  the  physiological 
conditions  involved. 

From  the  foregoing  discussion  of  mineral  metabolism,  we  learn  that 
the  salts  of  the  body  are  partly  bound  up  with  inorganic  substances  and 
partly  in  solution  in  the  body  fluids,  and  are  considered  as  ash.  The 
prevalent  custom  of  speaking  of  ash  as  a  food  is  incorrect;  properly 
speaking,  ash  is  the  term  applied  to  the  residue  remaining  after  the  incin- 
eration of  food  products  in  the  air  at  a  low  temperature,  until  the  carbon 
has  disappeared.  Ash  is  rather  an  indefinite  term  and  is  applied  to  that 
residual  material  of  a  mineral  nature  composed  of  sand  or  silica  and  the 
carbonate*  or  oxids  of  alkalies  or  alkaline  earths.  The  ash  contains  the 
principal  percentage  of  phosphorus  present  in  food  products  along  with  a 
small  portion  of  sulphur.   These  bodies  exist  as  phosphoric  and  sulphuric 


314 


nutritioin^  and  mineral  metabolism 


acids  or  their  salts.  Elements  so  closely  related  to  chemical  properties 
as  sodium,  potassium  or  calcium  and  magnesium  are  not  only  not  inter- 
changeable, but  in  some  of  their  functions  are  diametrically  opposed. 
Calcium  seems  to  bear  a  special  affinity  for,  and  to  exert  a  favorable 
influence  upon,  the  efficacy  of  iron  in  body  metabolism,  since  it  appears 
to  be  possible  to  maintain  iron  equilibrium  upon  a  smaller  amount  of  this 
latter  element  when  the  ingested  food  contains  an  abundance  of  the 
calcium  salts. 

The  relative  quantities  of  water,  organic  matter  and  inorganic  residue 
(ash)  in  some  of  the  tissues  and  body  fluids  is  shown,  in  the  following 
table : 

TABLE  SHOWING  PERCENTAGE  OF  WATER,  ORGANIC  MATTER  AND 

INORGANIC    RESIDUE    (ASH)    PRESENT    IN    CERTAIN    TISSUES 

AND  BODY  FLUIDS 


Water 

Organic  and 
volatile  matter 

Inorganic  resi- 
due (ash) 

Blood  corpuscles . 

Blood  serum 

54.60 
90.50 
95.70 
22.10 
10.00 
0.40 
79.50 
86.80 
87.00 
91.80 
91.80 
85.92 
90.97 
99.43 
99.50 

44.68 

8.68 

3.00 

26.00 

25.00 

3.60 

19.75 

12.85 

12.20 

7.40 

7.40 

13.30 

8.18 

0.33 

0.32 

0.72 
0.82 

Urine 

1.30 

Bone 

Dentine 

52.00 
65.00 

Enamel 

96.00     . 

Blood 

0.80 

Human  milk 

0.35 

Pus 

0.80 

LjTnph 

0.80 

Chyle 

0.80 

Bile 

0.78 

Pancreatic  iuice 

0.85 

Gastric  juice 

0.24 

Saliva 

0.18 

Acid-forming  and  Base-forming  Elements — The  ocic?-forming  and  hase- 
forming  elements  of  the  aliment  are  interesting  from  a  clinical  point  of 
view.  For  example,  a  dietary  of  proteins,  fats  and  carbohydrates  which 
has  been  demineralized  and  leaves  no  ash  residue  after  incineration,  will 
introduce  no  fixed  bases  in  the  body,  but,  on  the  other  hand,  will  introduce 
sulphuric  acid  from  the  metabolism  of  sulphur  contained  in  the  ingested 
protein.     Such  a  dietary  would  be  "acid-forming." 

Doctor  Taylor  (37),  of  the  University  of  California,  subsisted  for  a 
period  of  nine  days  upon  a  practically  ash-free  aliment  made  up  of  70-75 
grams  of  purified  egg  albumin,  120  grams  of  washed  olive  oil,  and  200 
grams  of  cane  sugar.     He  describes  his  symptoms  as  essentially  those  of 


FACTORS    WHICH    AFFECT    METABOLISM  315 

acidosis,  similar  to  that  produced  from  the  want  of  base-forming  elements 
in  the  diet.  Later  Goodall  and  Joslin(38)  carried  out  experiments 
similar  to  Taylor's  without  obtaining  confirmatory  evidence,  which  would 
suggest  considerable  differences  between  persons  in  reference  to  suscepti- 
bility of  the  acids  elaborated  in  the  metabolic  processes. 

Deprivation  of  the  organic  acids  leads  to  a  peculiar  disturbance  of  the 
system  resulting  in  the  development  of  scurvy.  Of  the  inorganic  salts 
sulphur  is  essential  to  growth.  The  chlorids  keep  the  globulins  in  solu- 
tion, and  are  the  source  of  the  hydrochloric  acid  of  the  gastric  juice.  The 
phosphates  are  essential  for  the  growth  of  bone  and  to  the  nervous  system. 
Deficiency  of  calcium  and  magnesium  leads  to  rickets  and  other  abnormal 
conditions. 

Gout  has  been  termed  the  disease  of  luxury.  On  the  other  hand, 
scurvy  is  the  disease  of  privation  or  penury.  Funk  and  other  writers  hold 
that  scurvy  is  a  deficiency  disease  due  to  lack  of  vitamines  in  the  food- 
stufts.  Gautier  held  that  the  class  of  vegetables  containing  a  liberal 
amount  of  alkaline  ash  acts  as  an  antiscorbutic. 

Sherman (39)  avers  that: 

If  susceptibility  to  scurvy  and  the  injurious  results  from  an  ash-free  diet  aie 
even  partly  due  to  the  disturbances  of  the  balance  of  acid-forming  and  base-form- 
ing elements  in  the  food,  it  would  seem  to  follow  that  the  normal  dietary  should 
be  so  chosen  as  to  furnish  the  body  enough  base-forming  elements  to  neutralize 
the  mineral  acids  produced  in  metabolism. 

This  author  determines  the  balance  of  acid-forming  and  base-forming 
elements  in  foodstuffs  by  ascertaining  the  presence  of  chlorin,  sulphur, 
phosphorus,  sodium,  potassium,  calcium  and  magnesium,  computing  the 
equivalent  in  acid  of  the  first  three  elements,  the  equivalent  in  alkali  of 
the  last  four,  then  determining  the  excess  of  acid  or  base,  as  the  case  may 
be,  which  would  result  from  the  complete  oxidation  in  the  blood.  He  holds 
that : 

While  in  actual  metabolism  all  of  the  siilphur  of  the  food  is  not  oxidized  to 
sulphate  and  the  ammonia  is  not  quite  all  converted  into  urea,  yet  the  method  is 
fairly  satisfactory  as  a  means  of  comparing  foodstuffs  in  respect  to  their  metabolic 
acid-forming  and  base-forming  properties. 

For  tables  graphically  showing  the  relative  preponderance  of  acid- 
forming  and  base-forming  elements  in  some  typical  foodstuffs,  as  worked 
out  by  Sherman,  consult  the  following  (Volume  II,  Cliapter  XI,  page  357). 

From  a  study  of  these  tables,  it  will  be  learned  that  lean  beef  and 
round  steak,  bacon  and  ham  possess  a  high  percentage  of  acid-forming 
elements.     It  will  also  be  seen  that  the  cereal  grains  show  a  slight  prepor- 

122 


316  NUTRITION  AND  MINERAL  METABOLISM 

derance  of  the  acid-forming  elements.  While,  in  the  second  table,  it  will 
be  seen  that  milk,  fruits  and  vegetables  show  an  excess  of  base-forming 
elements. 

The  blood  is  physiologically  and  chemically  an  alkaline  medium  and 
upon  its  alkalinity  depends  its  power  of  transporting  carbonic  acid,  and 
upon  this  fact  as  well  depends  the  power  of  .the  blood  to  take  up,  at  certain 
times,  organic  acids  without  itself  becoming  acid.  When  large  doses  of 
alkalies  are  administered,  the  economy  at  once  begins  preparing  for  their 
excretion,  so  that  a  short  while  after  absorption  only  a  small  portion  can 
be  found  present  in  the  organism. 

Just  how  alkali  is  retained  in  the  blood,  how  much  of  it  at  any  stated 
period  is  present  in  the  blood  and  lymph,  what  quantities  pass  into  the 
different  tissues  and  various  organs,  is  not  definitely  known.  And  yet 
an  accurate  understanding  of  this  interesting  phenomenon  would  be  of 
great  practical  significance  for  the  scientific  medical  man.  The  great 
variation  in  the  alkalinity  of  the  tissues,  though  often  challenged  by  thera- 
peutics, is  at  present  an  admitted  fact  Still  their  percentage  and  extent 
are  as  yet  "seen  through  a  glass  darkly." 

A  dietary  in  which  the  acid-forming  elements  are  present  in  excess 
calls  for  a  withdrawal  of  the  fixed  alkalies  from  the  tissues  and  circulating 
fluid  on  the  one  hand,  or,  on  the  other,  for  an  increase  of  ammonia  salts 
in  the  body,  neither  of  which  is  desirable.  Carnivorous  animals  habitually 
ingest  foods  with  an  excess  of  acid-forming  elements  without  harmful 
effects,  and  while  in  man  it  might  not  be  dangerous,  yet  it  must  put  an 
extra  tax  upon  a  constitution  accustomed  to  a  mixed  dietary  which  might 
better  be  avoided,  especially,  as  Sherman  thinks : 

TVe  have  no  reason  to  anticipate  any  disadvantages  from  a  preponderance  of 
base-forming  elements,  which,  if  not  used  to  neutralize  stronger  acids,  would  take 
the  form  of  biearbonates  and  thus  aid  in  the  maintenance  of  the  normal  and  neces- 
sary neutrality  or  faint  alkalescence  of  the  blood  and  tissues.  It  would  be  a  good 
practice,  therefore,  when  formulating  a  dietary  in  which  the  foods  contain  acid- 
forming  elements,  to  be  fairly  well  balanced  by  other  foods  in  which  the  base-form- 
ing elements  predominate,  so  that  the  diet  as  a  whole  may  yield  sufficient  fixed 
bases  to  neutralize  any  excess  of  mineral  acids  evolved  during  the  processes  of 
metabolism. 

If  all  the  available  information  could  be  collected,  with  the  opinions 
of  critics  added  thereto,  it  would  make  a  volume  in  itself.  Therefore,  we 
present  only  a  brief  prologue  to  mineral  metabolism  and  the  reader  is 
referred  to  the  succeeding  chapter  for  value  uses  and  sitology  of  the 
inorganic  salts. 


REFERENCES  317 


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318  NUTRITI0:N^  and   MIXERAL   METABOLISM 

24.  VoiT.     Herman's  Handbuch  der  Phjsiologie,  vol.  vi,  p.  396. 

25.  WiLLCOCK  and  Hopkins.     J.  Physiol. 

26.  Kauffmann.    Tigerstedt's  Physiology,  p.  109. 

27.  Howell.     Text-book  of  Physiology. 

28.  HuTciiisoisr.    Food  and  Dietetics. 

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30.  ScHNYDER.     Pfluger's  Archiv.,  1903,  vol.  xciii,  p.  451. 

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39.  Sherman.     Chemistry  of  Food  and  Nutrition. 


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Abderhalden.    Text-book  of  Physiological  Chemistry. 
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lilBLlOGliAPHY  319 

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Jordan,  Hart  and  Patton.  Metabolism  and  Physiological  Effects  of 
Phosphorus  Compounds  of  Wheat  Bran,  Technical  Bull.,  No.  1, 
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320  NUTRITION  AND  MINERAL  METABOLISM 

Shekman  and  Sinclair.  The  Balance  of  Acid-forming  and  Base-fonning 
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CHAPTER    XI 


SCIENTIFIC   FEEDING   OF   NITROGEN   FOODS 


"Man  begins  to  die  as  soon  as  he  is  born,"  but  a  competent  physician  who  under- 
stands the  science  of  trophotherapy  will  be  able  to  pilot  his  patient  through  the 
rocks  and  shoals  of  diet  and  land  him  in  a  haven  of  safe  and  enjoyable  life. 

Nitrogen  in  Diet:  Nitrogen  Equilibrium;  Nitrogen  in  Feces;  Low  Protein 
Diet;   High  Protein  Diet;  Nitrogen-free  Diet. 

Protein  Metabolism:  Urea;  Ammonia;  Creatinin;  Uric  Acid;  Purin  Bodies 
— Source,  Chemistry,  Occurrence  in  the  Body,  Purin  Bodies  in  Food, 
Effect  of  Purin  Foods  on  Uric  Acid,  Excess  of  Purin  Diet,  Purin-free 
Diet,  Low  Purin  Diet;  Fat-free  Diet;  Carbohydrate-free  Diet;  Cellu- 
lose Diet. 

Mineral  Metabolism:  Electrolytic  Properties  of  Salts;  Sodium  Chlorid; 
Salt-free  Diet;  Potassium  Chlorid;  Calcium  Diet;  Magnesium  Salts; 
Phosphorus;  Iron  Salts;  Sulphur  Salts;  Acid-forming  and  Base-form- 
ing Elements  of  Diet;  Resumg. 


NITROGEN   IN   DIET 

The  great  attention  that  food  both  in  health  and  disease  has  received 
in  recent  years  has  yielded  to  the  profession  of  medicine  valuable  infor- 
mation concerning  trophodynamics.  We  have  considered  experimental 
lesearches  in  regard  to  dietetics  conducted  largely  with  a  view  of  ascer- 
taining the  nutritive  value  of  food  material  in  regard  to  the  requisite 
quantities  for  supporting  life  and  maintaining  bodily  equilibrium  in  all  its 
phases  and  activities.  We  know,  too,  that  the  earliest  views  so  ardently 
promulgated  by  von  Liebig — that  there  is  a  direct  utilization  of  particular 
kinds  of  food  constituents  for  particular  purposes — do  not  strictly  hold 
true;  that  the  use  made  of  the  food  constituents  in  the  body  is  determined 
not  alone  by  the  nature  of  the  constituents,  but  to  a  certain  extent  by  the 

321 


322      SCIENTIFIC    FEEDING    OF    NITROGEN    FOODS 

relative  quantities  of  the  various  constituents  on  the  one  hand  and  by  the 
particular  needs  of  the  body  on  the  other ;  that,  for  example,  while  protein 
is  essential  in  food  for  construction  of  protoplasm,  either  in  growth  or 
repair,  when  it  is  ingested  in  amount  greater  than  is  required,  the 
excess  is  utilized  for  other  purposes — as  in  oxidation  to  yield  energy  or 
heat,  or  in  storage  as  glycogen  or  fat,  as  the  case  may  be.  Indeed,  it  must 
be  clearly  recognized  that  the  knowledge  of  the  food  constituents  as  they 
enter  the  body  and  the  end-products  of  metabolism  as  they  leave  the  body, 
yields  inadequate  information  as  to  the  intervening  processes  of  metab- 
olism which  may  or  may  not  follow  along  given  lines.  It  is  the  knowl- 
edge that  we  are  to-day  gaining  of  processes  of  intermediary  metabolism, 
that  is  shedding  new  light  on  phases  of  nutrition,  that  heretofore  have 
been  merely  conjectured  or  even  altogether  unknown  to  us. 

For  a  given  individual,  exercise  governs  largely  variations  in  the 
amount  of  food  required.  Within  certain  limits,  it  is  not  so  much  what 
form  the  food  is  in,  so  long  as  it  can  be  utilized.  Protein  metabolism  does 
not  depend  so  much  on  the  amount  of  exercise  as  it  does  on  the  amount 
and  proportion  of  protein  food  ingested.  Nitrogen  equilibrium  in  nor- 
mally healthy  individuals  may  be  maintained  on  various  amounts  of  pro- 
tein. It  is  determined  by  comparing  the  total  nitrogen  intake  with  the 
total  output.  If  the  amount  corresponds,  or  nearly  so,  the  body  is  said  to 
be  in  a  state  of  nitrogen  equilibrium.  Equilibrium  may  be  established 
at  a  low  level  on  partaking  of  small  amounts  of  protein  and  larger  amounts 
of  non-protein  food,  or  on  the  other  hand,  it  may  be  maintained  on  a  high 
level  by  partaking  more  freely  of  protein  with  correspondingly  less  non- 
protein. Chittenden  maintained  health,  strength  and  bodily  vigor  on  50 
grams  of  protein  daily.  On  the  other  hand,  nitrogen  equilibrium  has  been 
established  on  as  much  as  150  to  200  grams  of  protein  daily.  The  human 
economy  in  normal  conditions  regulates  the  amount  of  protein  metabol- 
ized to  both  the  amount  and,  as  well,  the  total  food  ingested. 

Nitrogen  Equilibriuin. — Major  Charles  E.  Woodruff,^  in  discussing  the 
nitrogen  equilibrium  in  the  tropics,  says : 

All  natives  of  the  tropics  (where  civilization  causes  over-population)  are  in  a 
condition  of  nitrogren  starvation  and  need  much  more  nitrogen  than  they  can  pos- 
sibly get.  The  old  standards  of  teaching  that  we  should  eat  as  the  natives  is  most 
vicious.  They  do  not  eat  meat  because  they  cannot  get  it.  They  crave  it,  need  it, 
and  eat  it  when  they  can.  On  account  of  the  destructive  effects  of  the  concen- 
trated tropical  actinic  rays  on  protoplasm,  we  need  more  nitrogen  than  at  home. 
Please  do  not  copy  the  old  falsehood  that  we  need  less.     It  is  also  true  that  we 

1  Major  Charles  E.  Woodruff,  Surgeon,  U.  S.  Army. 


NITROGEN"    IN    DIET  323 

need  fat,  as  it  furnishes  energy  better  than  carbohydrate.  It  is  eaten  in  prefer- 
ence to  starches  and  sugars  for  this  purpose  by  workers  when  they  can  afford  it, 
but  they  take  to  starch  (rice)  because  it  is  cheaper.  It  is  incorrect  to  say  that  it 
overheats.  It  does  not  overheat  us,  and  it  is  false  to  say  that  fat  is  not  needed  in 
the  tropics. 

Nitrogen  equilibrium  is  best  maintained  on  a  mixed  diet,  containing 
in  addition  to  the  protein  both  fat  and  carbohydrate.  If  the  non-protein 
portion  of  the  diet  is  reduced,  other  things  being  equal,  there  will  be  a 
nitrogen  loss,  owing  to  the  fact  that  more  protein  is  used  to  supply  the 
heat  and  energy  that  formerly  was  supplied  by  the  greater  amount  of  non- 
protein food.  It  takes  some  days  to  establish  a  nitrogen  equilibrium  when 
the  usual  diet  of  an  individual  is  changed.  Say  that  the  ordinary  dietary 
contains  IG  grams  of  nitrogen  and  the  diet  is  suddenly  changed.  It  will  be 
several  days  before  equilibrium  will  be  established  on  a  new  level,  whether 
it  be  above  or  below  the  amount  usually  metabolized.  A  slight  loss  of  a 
transient  character  will  be  noted  when  the  intake  is  lessened,  but,  if  the 
loss  persists,  it  means  that  either  too  little  protein  is  being  taken  in  the 
food,  or  that  the  total  caloric  value  of  the  food  is  below  the  normal  amount 
required,  or  the  body  is  affected  with  some  wasting  disease  attended  with 
nitrogen  loss. 

Nitrogen  in  Feces — In  determining  the  available  nitrogen  in  food, 
attention  must  be  given  to  the  nitrogen  of  the  feces.  The  feces  consist  of 
the  undigested  residue  of  the  food,  together  with  nitrogen  from  mucus, 
worn  out  epithelial  cells  from  the  walls  of  the  alimentary  tract,  bacteria, 
coloring  matter,  bile  and  other  residue.  Therefore,  the  contention  that  all 
the  nitrogen  in  the  feces  is  derived  from  the  food  is  erroneous.  That 
which  is  derived  from  the  bile,  mucus  and  debris  of  broken-down  epithelial 
cells  is  body  waste,  and  has  already  been  added  to  the  nitrogenous  content 
of  the  organism.  During  a  fast,  when  no  food  is  consumed,  bile  and  mucua 
are  still  secreted,  and  the  epithelial  cells  continue  to  break  down  and  bac- 
teria continue  to  flourish,  and  are  expelled  with  the  feces.  Reider  con- 
ducted experiments  with  a  nitrogen-free  food,  which  he  previously  ascer- 
tained to  be  readily  digestible.  The  subject  was  a  man  of  medium  height 
and  weight.  The  ration  was  a  cake  made  from  starch,  sugar,  fat  and  a 
little  salt  leavened  with  cream  of  tartar  and  bicarbonate  of  soda.  White 
wine  and  water  in  small  quantities  were  the  only  beverages  and  were 
free  of  nitrogen.  This  ration  was  ingested,  he  believed,  in  sufficient 
quantities  to  secure  normal  secretion  of  the  digestive  juices.  On  such  a 
diet,  the  inference  is  that  any  nitrogen  found  in  the  feces  could  be  attrib- 
uted to  body  sources  only.     The  average  amount  of  nitrogen  in  the  feces 


324       SCIENTIFIC   FEEDING    OF    NITROGEN    FOODS 

during  this  experiment  was  0.5  grams  per  day,  which  may  be  taken  to 
represent  fairly  the  amount  of  nitrogen  in  the  feces  arising  from  body 
waste ;  any  amount  above  this  figure  ordinarily  may  be  attributed  to  resi- 
due from  the  food. 

Low  Protein  Diet. — The  low  protein  diet  of  Chittenden  has  been  re- 
ferred to  above  and  in  Volume  II,  Chapter  V.  He  and  his  followers 
urge  but  little  protein  above  the  minimum,  together  with  the  requisite 
amount  of  fat  and  carbohydrates  to  make  up  the  needed  calories.  They 
urge  that  on  this  diet  health  and  weight  may  be  maintained  and  that  the 
mental  and  physical  efficiency  is  greater  than  when  more  liberal  diets  are 
allowed. 

The  experiments  of  Chittenden  are  of  enormous  practical  value  in 
showing  that  a  low  protein  diet  can  be  used  for  a  long  period  of  time  with- 
out danger  (see  table,  Volume  II,  Chapter  IX,  p.  254).  Low  protein 
diets  are  of  value  in  gout  and  all  gouty  affections,  in  diseases  involving  the 
tegumentary  system,  more  particularly  when  accompanying  disorders  of 
metabolism,  in  treating  the  ill  effects  of  habitual  overeating  and  arterio- 
sclerosis, and  in  fevers  and  other  affections.  Brain  workers  and  others 
following  sedentary  vocations  will  no  doubt  do  better  on  diets  lower  in 
protein  than  usually  advised.  After  carefully  considering  all  the  points 
of  a  low  protein  diet,  we  are  led  to  the  conclusion  that  it  is,  at  the  same 
time,  a  low-purin  diet;  and  many  authorities  believe  that  the  beneficial 
effects  are  due  in  part  to  the  freedom  of  a  low-protein  diet  from  punn 
bodies.  Many  clinicians  find  there  are  only  a  few  cases  of  gout  where 
a  moderate  quantity  of  animal  food  does  harm,  and  many  where  it  exerts 
a  beneficial  effect.  As  a  matter  of  fact,  the  major  portion  of  the  human 
race  will  go  on  eating  and  drinking  and  "making  merry,"  according  to 
their  appetites  and  their  ability  to  gratify  them.  Still,  on  the  other  hand, 
the  problem  is  one  of  the  highest  human  interest,  particularly  in  refer- 
ence to  the  "dietary  in  disease,"  and  in  preventing  disease  when  danger 
signals  loom  in  the  distance.  It  is  interesting  to  compare  the  navy  diets 
(see  Volume  II,  Chapter  XVIII),  which  are  essentially  high  protein  diets, 
for  the  reason  that  the  sailor  prefers  it,  and  is  more  contented  and  does 
better  work  than  when  on  perhaps  a  more  healthful  protein,  but  for  him 
less  appetizing,  diet. 

Below  we  append  a  standard  for  a  low  protein  diet : 

LOW  PROTEIN  DIETARY 

In  the  morning  upon  waking  5  to  10  ounces  of  hot  water  containing  10  to  20 
grains  of  sodium  bicarbonate  or  potassium  citrate.    Half  an  hour  later: 


NITROGEN    IN    DIET  325 

Breakfast: 

A  large  plate  of  fruit  and  milk  or  cream,  followed  by  abundant  cereal  and  milk 
with  bread  and  butter.     No  meat,  eggs  or  fish.    Wait  five  hours. 
Dinner: 

Not  more  than  four  ounces  of  meat  or  fish,  which  must  be  quite  fresh;  a  very 
large  plate  of  green  vegetables,  potatoes  sparingly,  and  nothing  more  than  a 
taste  of  sweets.    Five  hours  later: 
Supper: 

May  be  a  repetition  of  breakfast,  but  succulent  vegetables  may  replace  the  fruit, 
and  macaroni  or  a  similar  dish  may  be  substituted  for  the  cereal. 

TEirst  and  hunger  between  meals  may  be  satisfied  by  water  and  fruit  about  one 

hour  before  a  meal  or  during  the  night. 
Abstain  from  meat  juices  (gravy  and  soup),  gelatin,  coffee,  tea,  cocoa,  salt  and 

strong  condiments,  alcohol,  pastry. 
AH  starches  and  meats  must  be  well  cooked. 

High  Protein  Diet — A  high  protein  diet,  according  to  Yoit's  standard 
from  118  to  120  grams  of  protein  daily,  may  be  of  use  in  certain  condi- 
tions— during  pregnancy,  lactation,  in  convalescing  from  wasting  diseases, 
in  the  beginning  of  physical  training  when  muscular  growth  is  great,  and 
in  combating  certain  diseases  like  tuberculosis,  etc.  During  growth  the 
protein  requirements  are  higher  than  in  adult  life,  but,  on  the  other  hand, 
high  protein  diets  are  objectionable  for  individuals  who  follow  sedentary 
occupations,  and  for  all  of  those  conditions  benefited  by  a  low  protein  diet. 
When  studying  the  subject  of  Protein  and  Nutrition  in  Volume  II,  Chap- 
ter IX,  we  learned  the  minimum  amount  of  low-protein  diets  to  be  60 
grams,  and  for  a  high-protein  diet,  120  grams;  this  leaves  rather  a  wide 
range,  and  it  is  safe  to  say  that  the  optimum  lies  between  these  two.  We 
do  not  believe  that  any  standard  will  ever  be  definitely  fixed  that  will  be 
of  universal  application,  but  we  are  inclined  to  believe  that  future  stand- 
ards will  be  worked  out  to  cover  the  various  classes  and  normal  condi- 
tions, as  well  as  in  different  disturbances  of  metabolism.  To-day  the 
standards  that  are  being  put  into  practical  use  for  tuberculous  patients, 
contain  30  per  cent  of  protein  above  the  normal.  In  nephritis  60  to  YO 
grams  are  allowable;  in  fevers,  70  grams,  etc. 

Nitrogen-free  Diet — A  nitrogen-free  diet  can  "be  made  from  starch, 
sugar,  salt  and  almond  oil  or  other  fat.  This,  material  can  be  made  pala- 
table and  baked  into  a  cake,  with  baking  powder  for  leavening.  There  is 
no  very  great  therapeutic  use  for  a  nitrogen-free  diet  nor  is  it  conceivable 
that  an  individual  would  he  satisfied  with  it  for  very  long.  Its 
principal  use  seems  to  he  chiefly  for  exp'erimental  purposes,  especially 
when  it  is  desired  to  make  observations  on  the  metabolism  of  nitrogen. 


326     scie:n^tific  feeding  of  nitrogen  foods 

Lehman  observed  that  when  a  man  consumed  a  nitrogen-free  diet  for  a 
period  of  three  days,  he  excreted  daily  7.4  grams  of  nitrogen.  Keider, 
in  a  similar  experiment,  found  that  the  average  excretion  of  nitrogen  by 
the  kidneys  was  8 . 7  grams  and  the  feces  contained  0 . 9  grams,  which  was 
equivalent  to  a  loss  of  56  grams  of  protein  daily.  Physiologists  have  not 
yet  determined  just  how  much  "floating  protein,"  or  more  correctly 
amino-acids,  there  is  in  the  human  organism.  It  varies  daily;  but  it  is 
safe  to  say  that  all  the  floating  protein  could  be  consumed  in  a  very  few 
days.  If,  for  any  reason,  it  should  be  determined  to  rid  the  system  of 
"floating  protein,"  it  may  be  done  by  giving  a  comparatively  free  nitrogen 
aliment  for  a  short  period  of  time.  This  diet  may  be  selected  from  the 
foods  given  in  the  table  below,  showing  the  percentages  of  protein  in 
foods : 

PERCENTAGES  OF  PROTEIN  IN  PROTEIN-POOR  FOODS 


Foods  containing 

Foods  containing 

Foods  containing 

Foods  containing 

0.5  per  cent  or 

0.5  to  1.0  per  cent 

1  to  1.5  per  cent 

more  than  2  per 

less  protein 

protein 

protein 

cent  protein 

Arrowroot  starch, 

Manioc  starch,  ar- 

Grapes,   bananas. 

Potatoes,    string 

corn  starch,  sugar, 

rowroot,      sago, 

leeks,  onions. 

beans,  artichokes, 

honey,  cottonseed 

tapioca,    apples. 

cabbage,  celery, 

lard,  thick  cream, 

oil,  almond  oil. 

pears,    plums. 

squash,  parsnips. 

fat  salt  pork,  fat 

rhubarb,    toma- 

cauliflower, 

ham,   bone  mar- 

toes, cucumbers. 

sauerkraut, 

row. 

radishes,  turnips. 

horseradish,    to- 

oranges, lemons. 

mato        catsup, 

raspberr  i  es. 

butter. 

gooseberries, 

strawberries. 

After  taking  a  diet  consisting  of  the  foregoing  fruits  and  vegetables 
for  four  days,  some  bread,  rice,  oatmeal,  milk  pudding  or  soup  may  be 
added  to  the  list.  The  amount  of  protein  in  these  foods  is  as  follows: 
Beef  soup,  .4  per  cent;  meat  stew  (when  meat  is  taken  out),  4.6;  oxtail 
soup,  4.0  ;  chicken  broth,  3.6  ;  tomato  soup,  1.8  ;  vegetable  soup,  2.8 ;  milk, 
3.5  ;  boiled  rice,  2.8 ;  boiled  oatmeal  (thick),  2.8 ;  brown  bread,  5.5  ;  white 
bread,  8  or  9 ;  zwieback,  9.8  per  cent.  The  return  to  the  ordinary  diet, 
or  one  containing  at  least  55  grams  of  protein  daily,  should  not  be  deferred 
longer  than  the  eighth  day. 

Spirits  contain  no  protein.     The  amount  in  wine  is  practically  negli- 
gible, and  an  infusion  of  cereal  coffee  (1  in  20)  contains  only  0.2  per  cent 


riiOTEIiNT    METiUiOLISM  327 

of  protein.  The  choice  of  foods  is  large,  and  such  a  diet,  while  yielding 
sufEcient  energy,  would  speedily  result  in  a  clearance  of  superfluous  pro- 
tein materials. 

We  have  learned  that  cell  metabolism  is  attended  by  changes  of  a 
destructive  nature.  Carbon  is  oxidized,  yielding  carbon  dioxid ;  hydrogen 
unites  with  oxygen  and  forms  water.  Nitrogen  is  burned  oif,  but  only 
partially  reduced,  urea  being  the  chief  product  of  protein  metabolism. 
It  is  formed  largely  in  the  liver,  but  it  is  very  probable  that  other  cellular 
organs,  such  as  the  spleen  and  lymphatic  glands,  participate  in  its 
formation. 

BROTEIN    METABOLISM 

In  the  study  of  the  Physiology  of  Enzymes  and  Hormones  as  Applied 
in  the  Process  of  Digestion  (Volume  I,  Chapter  VI),  we  learned  that  the 
protein  molecules,  on  being  metabolized  in  the  body,  yield  varying  amounts 
of  arginin,  which  ultimately  undergoes  hydrolysis  into  omithin  and  urea. 
In  this  way  it  is  possible  to  trace  an  appreciable  part  of  the  nitrogen  of 
protein  to  the  urea  stage  through  a  series  of  direct  cleavages.  The  protein 
in  digestion  and  in  catabolism  is  split  into  amino-acids,  which  are  even- 
tually deaminized,  the  nitrogen  of  the  amino-group  being  split  off  as  am- 
monia. This,  with  carbonic  acid,  forms  ammonium  carbonate  or  car- 
bamate which  is  transformed  into  urea  by  various  organs  of  the  body, 
notably  by  the  liver,  as  stated  above. 

The  important  nitrogenous  end-products  of  protein  metabolism  other 
than  urea,  are  ammonium  salts,  purin  bodies  and  creatinin. 

Urea. — Protein  metabolism  has  heretofore  been  considered  to  be  quali- 
tatively better,  in  proportion  as  a  larger  percentage  of  the  urinary  nitro- 
gen is  eliminated  as  urea  and  a  smaller  moiety  in  other  forms.  This, 
however,  is  not  always  the  case,  since  this  may  be  largely  a  matter  of  the 
amounts  of  protein  consumed. 

According  to  Folin,  who  made  a  careful  and  extended  study  of  urines 
of  healthy  men  partaking  first  of  a  high  and  then  of  a  low  protein  diet, 
the  distribution  of  nitrogen  between  urea  and  other  nitrogenous  end-prod- 
ucts depends  very  largely  upon  the  absolute  amount  of  nitrogen  metab- 
olized. He  observed  a  man  who  was  fed  on  a  high  protein  diet  (free 
from  meat)  for  one  day  and  at  the  end  of  the  week  was  partaking  of  a 
diet  composed  of  starch  and  cream,  which  furnished  in  all  about  6  grams 
of  protein  per  day.  The  end-products  of  his  protein  metabolism  are 
shown  in  the  following  table  from  Sherman: 


328       kSCIENTIFIC    FEEDING    OF    NITROGEN    FOODS 


END  PRODUCTS  OF  PROTEIN  METABOLISM  ON    BOTH   HIGH  AND 

LOW  PROTEIN   DIET 


Nitrogenous  end  products 
of  protein  digestion 

On  high  protein  diet 
(free  from  meat) 

On  low  protein  diet 
(starch  and  cream) 

Grams 

Per  cent 

Grams 

Per  cent 

Total  nitrogen 

16.8 
14.7 
0.49 
0.18 
0.58 
0.85 

87.5 
3.0 
1.1 
3.6 
4.9 

3.6 

2.2 

0.42 

0.09 

0.60 

0.27 

Urea  nitrogen 

61.7 

Ammonia  nitrogen 

11.3 

Uric  acid  nitrogen 

2.5 

Creatinin  nitrogen 

17.2 

Undetermined  nitrogen 

7.3 

An  examination  of  this  table  shows  there  was  a  marked  decrease  in 
both  the  absolute  and  relative  amounts  of  urea,  as  well  as  a  decrease  in 
the  absolute,  but  an  increase  in  the  relative  amount  of  uric  acid  excreted, 
while  the  absolute  amount  of  creatinin  remained  stationary. 

Regarding  the  urea  of  the  circulating  blood,  Dr.  Denis,  of  the  Massa- 
chusetts Hospital,  1  found  that  the  intake  of  ordinary  protein  may  be  in- 
creased from  the  amount  sufficient  to  give  from  6  to  8  grams  of  urea  in 
the  24-hour  urine,  to  that  sufficient  to  produce  a  daily  urea  excretion  of 
from  30  to  50  grams  without  producing  any  material  increase  in  the  cir- 
culating urea.  Until  recently,  we  depended  entirely  upon  the  analysis  of 
the  urine  to  determine  the  metabolism  of  any  dietary  regimen.  The  toler- 
ance of  the  human  economy  for  carbohydrate  food  was  ascertained  by 
examination  of  the  secretion  from  the  kidneys  for  sugar  after  an  ingestion 
of  varying  quantities  of  this  type  of  foodstuff.  The  ability  of  the  kid- 
neys to  excrete  the  waste  products  of  inorganic  salts  was  likewise  ascer- 
tained by  urinary  analysis  and  the  efficiency  of  the  renal  fimetions  was 
judged  on  this  basis.  The  more  advanced  methods  for  the  analysis  of 
very  small  quantities  of  blood — so-called  micro-analysis — has  transformed 
the  seat  of  observation  to  the  circulating  fluid  in  the  vascular  system.  To- 
day blood  analysis  for  clinical  purposes  is  making  rapid  strides,  not  only 
so  far  as  qualitative  tests  are  concerned,  but  for  quantitative  tests.  At 
the  present  time,  methods  for  the  determination  of  the  sugar  content  of 
the  blood  are  in  use ;  likewise,  the  estimation  for  non-protein  nitrogen, 
urea,  creatinin,  uric  acid,  fats  and  lipoids  has  been  brought  within  the 
scope  of  a  feasible  determination  on  small  samples  of  blood. 


1  Editorial,  J,  Am.  M.  Ass.,  1917. 


PROTEIN    METxVBOLISM  329 

Ammonia. — As  previously  stated,  ammonia  is  evidently  a  normal  pre- 
cursor of  urea,  being  changed  into  the  latter  during  its  passage  through 
the  liver.  According  to  this  assumption  the  elimination  of  nitrogen  as 
ammonia  may  be  notably  increased  at  the  expense  of  urea :  (a)  by  the 
ingestion  of  mineral  acids,  or  of  food  yielding  unusual  amounts  of  such 
acids  by  oxidation  in  the  body;  (b)  in  cases  yielding  an  excess  of  acids  in 
metabolism,  as  the  acidosis  of  diabetes,  fevers  (inanition)  and  pregnancy; 
(c)  in  structural  diseases  of  the  liver  (acute  yellow  atrophy).  It  will  be 
seen  that  the  first  and  second  methods  increase  the  ammonia  by  "fixing" 
it  as  salts,  thus  preventing  its  transformation  into  urea,  while  the  third 
diminishes  the  ability  of  the  system  to  effect  such  transformation. 

Creatinin — Xonnal  urine  contains  about  1.5  grams  of  creatinin  per 
day.  The  origin  and  significance  of  endogenous  creatinin  and  especially 
its  physiological  relations  to  creatin  (of  which  it  is  chemically  the  anhy- 
drid)  is  still  unsettled,  despite  much  clinical  research.  It  seems  to  depend 
on  the  musculature  of  the  individual.  The  amount  excreted  is  not  gov- 
erned by  the  amount  of  protein  consumed,  therefore  the  percentage  of 
urinary  nitrogen  appearing  in  this  form  tends  to  increase  as  the  total 
nitrogen  diminishes  and  vice  versa.  Sherman  and  Lusk  agree  Avith  the 
above  statement,  but  Folin,  after  an  extended  study  of  the  urines  of 
healthy  men  partaking  first  of  a  high  and  then  a  low  protein  dietary,  con- 
cluded that  the  nitrogen  excretion  depended  largely  upon  the  amount  of 
nitrogen  metabolized. 

Uric  Acid. — The  former  theory  as  to  the  production  of  uric  acid  in 
the  body  was  that  it  represented  protein  imperfectly  oxidized  into  urea 
and  that  the  uric  acid  diathesis  was  a  condition  of  suboxidation  in  which 
the  uric  acid  acted  directly  as  a  toxic  agent.  Of  late,  researches  of  physio- 
logical chemists  have  considerably  modified  this  view,  and  it  is  now  held 
that  uric  acid  and  allied  purin  bodies  are  entirely  independent  of  the 
general  catabolism  of  protein  matter.  It  is  a  product  of  the  final  stage 
of  catabolism  of  the  purin  bodies  that  in  Volume  I,  Chapter  III,  we  have 
seen  enter  into  the  construction  of  the  nuclein  and  nucleoproteins.  There- 
fore, the  general  clinical  conception  of  the  uric  acid  diathesis  might  be 
better  termed  "purinemia,"  Benedict(l). 

Purin  Bodies — SOURCE.— Purin  bodies  are  nitrogenous  substances  con- 
structed on  the  purin  framework,  05^4.  They  include  uric  acid,  xanthin, 
hypoxanthin,  adenin  and  guanin,  and  closely  related  are  methvlxanthin 
and  theobromin.  Fischer  has  shown  the  relation  of  all  these  bodies  to 
purin.  They  contain  a  central  chain  of  three  carbon  atoms  to  which  is 
attached  on  each  side  a  urea  group,  so  that  they  may  be  regarded  as 


330      SCIENTIFIC    FEEDING   OF   NITROGEN   FOODS 

diureids.  These  bodies  arise  from  nueleoproteiu,  the  components  of 
which  are  normal  constituents  of  the  nucleus  and  protoplasm  of  cells.  In 
the  human  economy  the  nucleoproteins  are  split  into  nuclein  and  protein, 
and  finally  the  nucleic  acid  into  purin  bodies,  pyrimidin  bases,  phosphoric 
acid  and  sugars.  This  is  the  normal  order  of  the  metabolic  breakdown  of 
nucleoproteins,  and  it  occurs  in  some  animals  as  well  as  in  human  beings. 
As  a  group  the  purin  bodies  are  said  to  raise  blood  pressure  and  tend  to 
produce  angiosclerosis  and  various  sclerotic  changes  in  the  viscera. 

In  studying  the  characters  of  the  proximate  principles  of  foodstuffs 
(Volume  I,  Chapter  III),  we  considered  at  some  length  the  chemistry  of 
purins  and  purin  compounds,  as  also  the  pyrimidin  bases  to  which  the 
reader  is  referred. 

CHEMISTRY. — Although  current  text-books  on  dietetics  barely  mention 
the  chemistry  of  the  individual  purins,  yet  we  consider  them  of  sufficient 
importance  to  state  some  of  the  principal  facts  which  underlie  their  gi'oup 
reactions  in  order  to  delineate  the  several  phases  of  nuclein  metabolism. 
According  to  Hall (2),  the  purin  compounds  crystallize  easily,  are  more 
or  less  soluble  in  the  usual  solvents,  and  can  now  be  oxidized  and  reduced. 
Hypoxanthin  yields  small  crystalline  scales  with  sharpened  extremities 
almost  like  grains  of  wheat.  Xanthin  may  be  distinguished  by  its  thin, 
flat,  glistening  rhombic  plates,  guanin  by  small  prismatic  crystals  or 
amorphous  masses,  adenin  by  long  needle-shaped  prisms,  and  uric  acid 
by  rhombic  plates.  Rarer  forms  have  been  demonstrated  by  variations  in 
the  media  and  rapidity  of  crystallization. 

Their  solubilities  present  the  following  remarkable  differences: 

SOLUBILITY    OF   PURIN   COMPOUNDS 


Water 
Cold 
Hot 

Alkalies 

Hypoxanthin 
1:300 

1:78 

Xanthin 
1:13000 
1:1300 

Adenin 
1:1086 

Uric  Acid         Guanin 
1:16000         Insoluble 
1:1600 

Weak 
Acids 

Soluble 

a 

Soluble 

u 

Spluble 
« 

Soluble     Slightly  soluble 
Insoluble        Soluble 

From  a  (Synthetic  standpoint  the  purin  bodies  are  exceedingly  interest- 
ing. About  twelve  different  derivatives  of  the  purin  nucleus  are  known 
to  exist  in  nature,  but  not  less  than  146  have  been  produced  in  the  labora- 
tory. The  closely  related  caffein  and  theobromin  are  largely  used  as 
medicaments  for  their  stimulative  and  diuretic  properties,  and  it  is  possi- 
ble that  in  the  near  future  these  may  be  made  synthetically.  Triehlor 
purin,  obtained  by  the  action  of  phosphorus  chlorid  upon  uric  acid,  occu- 
pies a  position  midway  between  uric  acid  and  the  methylxanthins,  caffein, 


PKOTEIN    METABOLISM  331 

theobromin  and  theophjlin.  Emil  Fischer,  in  his  lucid  and  interesting 
address  given  in  Stockhohn  in  November,  1902,  after  the  distribution  of 
the  Nobel  prize,  draws  a  picture  of  the  time  when  the  present  coffee 
adulterants — cliicory  and  coffee  surrogate — will  be  superseded  by  syn- 
thetically made  caft'ein,  and  suggests  a  period  when  coffee  beans  and  their 
roasting  will  be  unnecessary,  since  the  solution  of  a  small  powder  in  hot 
water  will  give  a  well  flavored,  refreshing  drink  at  a  much  lower  cost  and 
with  much  less  trouble  than  the  present  conditions  necessitate. 

OCCURRENCE  IN  THE  BODY.— Purin  bodies  exist  ready  formed  in 
many  of  our  foods,  especially  those  in  the  animal  kingdom;  but  on  the 
other  hand,  the  system  can  produce  its  own  nuclein  and  the  higher  com- 
pounds of  nuclein  on  a  diet  free  from  purins,  though,  of  course,  containing 
proteins.  Further,  the  elimination  of  purins  is  somewhat  increased  by 
increasing  the  intake  of  proteins,  about  half  of  the  elimination  of  purins 
on  an  ordinary  mixed  diet  being  accounted  for  by  the  ingestion  of  more 
or  less  combined  purins,  and  about  half  by  the  metabolism  of  nuclein- 
containing  structures,  such  as  white  blood  cells  and  the  cells  of  viscera, 
namely,  the  kidneys,  liver,  pancreas,  spleen  and  thjTnus.  The  old  theory 
that  no  purin  bodies  are  formed  except  from  purins  is  false,  while  the 
older  view  that  uric  acid  is  a  precursor  of  urea  is  true  in  a  limited  sense 
only.  Lusk,  referring  to  the  successive  steps  in  purin  metabolism,  states 
that  deaniination  is  brought  about  through  the  action  of  specific  enzymes 
as  follows:  "Sunnnarizing  these  results,  it  may  be  said  that  nucleic  acid 
may  be  broken  up  by  nuclease,  a  ferment  found  in  all  tissue.  On  the  lib- 
eration of  the  purin  bases,  guanin  and  adenin  are  deaminized  by  guanase 
and  adenase  wherever  these  enzymes  are  found.  Oxidizing  enzymes,  the 
xanthin  oxidases,  now  convert  hypoxanthin  and  xanthin  into  uric  acid, 
while  a  uricolytic  ferment  of  varying  potency  in  different  tissues  in  dif- 
ferent animals  may  break  up  and  destroy  the  uric  acid." 

Purins  occur  in  both  animal  and  vegetable  nitrogenous  bodies,  in 
greater  abundance  in  the  former  and  obviously  in  still  greater  abundance 
in  glandular  viscera  and  white  blood  cells  than  in  muscle  and  connective 
tissues,  on  account  of  the  relative  preponderance  of  nuclei,  while  vege- 
table nuclein  occurs  richly  in  yeast  cells.  The  purins  which  are  con- 
sumed with  the  food  are  termed  exogenous  purins,  and  those  excreted  by 
a  healthy  normal  individual  independent  of  his  food — the  result  of  the 
metabolism  of  his  own  tissues — endogenous  purins. 

The  daily  "wear  and  tear"  on  metabolism  of  cell  constituents  leads  to 
the  production  of  a  certain  amount  of  purin  bodies.  These  substances  con- 
stitute the  "endogenous"  purins  of  the  excreta.    When  tissues  containing 


332       SCIENTIFIC    FEEDING    OF    NITROGEN    FOODS 

nucleins  or  free  purins  are  eaten,  the  "endogenous"  purins  of  the  food 
ingested  become  "exogenous"  to  the  system  which  absorbs  them.  As  "en- 
dogenous" purins  are  practically  waste  products  on  their  way  to  excretion, 
when  they  become  "exogenous"  to  another  organism  they  have  little  nutri- 
tive value  and  demand  early  and  rapid  elimination.  This  is  generally 
effected  by  deaminization  of  guanin  and  adenin  and  the  oxidation  of  the 
oxypurins,  hypoxanthin  and  xanthin  to  uric  acid,  and  then  the  purin  ring 
or  chain  in  the  uric  acid  is  in  the  system,  probably  chiefly  in  the  liver, 
partially  split  off  and  a  portion  of  the  uric  acid  excreted  as  urea.  The 
course  followed  in  the  case  of  the  nucleins  is  not  quite  clear,  as  a  smaller 
percentage  appears  in  the  urine  as  uric  acid. 

The  amount  of  purins  excreted  in  the  virine  due  to  endogenous  forma- 
tion may  be  estimated  after  taking  a  purin-free  diet  for  a  few  days,  and 
the  amount  varies  from  0.1  to  0.2  grams  per  day (3).  The  exogenous 
purins  are  principally  transformed  in  the  body,  50  per  cent  being  ex- 
creted as  urea  and  the  remaining  portion  being  eliminated  by  the  kidneys 
as*  uric  acid  with  some  xanthin  and  hypoxanthin. 

We  can  apply  the  term  "free-purins"  to  purin  bodies,  and  "bound- 
purins"  to  the  purins  of  nucleic  acid,  nuclein  and  nucleoproteins.  The 
process  of  purin  formation  goes  on  throughout  life  as  a  part  of  the  cell 
metabolism,  but  the  transformation  of  purin,  likewise,  goes  on  constantly. 
A  number  of  enzymes  cooperate  in  the  transformation  of  purin-containing 
materials,  for  instance,  nucleases  liberate  guanin  and  adenin  from  nucleic 
acid,  these  aminopurins  being  converted  by  the  enzymes  guanase  and 
adenase  into  xanthin  and  hypoxanthin  respectively,  and  oxidases  trans- 
form hypoxanthin  to  xanthin  and  then  to  uric  acid.  The  latter  is  finally 
to  a  certain  extent  decomposed  and  destroyed  by  uricolytic  enzymes  of 
varying  potency  present  in  the  various  organs. 

Hypoxanthin  and  xanthin  are  often  obtained  as  products  of  decompo- 
sition of  nucleic  acid,  but  are  generally  formed  by  the  deaminization  and 
oxidation  of  guanin  and  adenin. 

It  is  now  generally  conceded  that  certain  purin  bodies  are  constantly 
being  produced  wherever  cellular  processes  are  in  active  operation,  and 
although  normally  these  are  largely  converted  into  other  materials  which 
are  more  easily  excreted,  practically  all  nitrogenous  animal  foods  contain 
some  of  them.  Lean  meat,  the  flesh  of  mammals,  birds  and  fish,  contains 
xanthin,  hypoxanthin  and  uric  acid,  besides  urea,  creatin,  creatinin  and 
other  extractives.  Liver  is  rich  in  nuclein,  xanthin,  hypoxanthin,  urio 
acid,  urea  and  other  nitrogenous  extractives.  Spleen  (milt)  also  is  rich 
in  nuclein,  xanthin,  hypoxanthin,  uric  acid,  as  well  as  lecithin,  creatinin. 


PKOTEIiX    METABOLISM  333 

leucin  and  tyrosin.  Thymus  (chest  sweetbread)  contains  nuclein,  xanthin, 
hypoxanthin,  guanin  and  adenin  in  large  amounts.  Pancreas  (belly 
sweetbread)  contains  the  same  kinds  of  purins,  besides  leucin,  tyrosin  and 
other  amino-acids.  Kidneys  contain  uric  acid,  xanthin,  hypoxanthin,  as 
also  urea,  tuarin,  leucin,  creatin,  creatinin,  etc.  Beef-tea,  soup  and  gravy 
contain  the  same  kinds  of  purins  and  extractives  as  the  substances  from 
which  they  are  derived.  Vegetable  foods,  especially  seeds,  contain  nucleo- 
proteins,  nuclein,  nucleic  acid,  and  purin  bodies,  with  aminoacids,  such 
as  asparagin,  leucin,  tyrosin,  etc.  Tea,  coffee  and  kola  contain  caffein 
or  trimethyl-xanthin — that  is,  xanthin  with  three  methyl  groups  in  its 
molecule;  cocoa  contains  theobromin  or  dimethyl-xanthin ;  and  guarana 
contains  both  caft'ein  and  theobromin. 

As  already  stated,  according  to  Burian,  all  of  the  exogenous  purins 
are  not  excreted ;  a  small  fraction  remains  in  the  organism  or  becomes 
entirely  disintegrated  by  the  oxidases  of  the  various  organs.  Therefore, 
on  ordinary  diets,  while  the  excretion  of  purin  is  necessarily  increased  by 
the  exogenous  or  food  purin,  not  all  that  is  ingested  is  eliminated  as  such. 
The  amount  of  exogenous  purin  excreted  in  the  urine  is  scarcely  influenced 
by  the  individuality  of  the  subject,  usually  the  purin  excretion  in  normal 
individuals  being  practically  the  same ;  but  it  must  be  borne  in  mind  that 
its  excretion  is  largely  influenced  by  certain  foods.  For  instance,  in  beef 
and  veal,  the  purin  content  is  0.16;  calf's  liver,  0.12;  calf's  spleen,  0.16; 
calf's  thymus,  0.4,  and  in  coffee,  0.2  per  cent.  When  these  organs  are 
largely  partaken  of  or  eaten  alone,  they  lead  to  excretion  of  exogenous 
purin  in  the  following  proportions :  beef  and  veal,  0.03 ;  liver,  0.06 ; 
spleen,  0.8;  thymus,  0.1;  coffee,  0.075.  Burian  and  Schurr  as  a  result 
of  their  researches  conclude  that  with  the  identical  kind  and  same  pro- 
portion of  food  the  exogenous  purin  in  the  urine  is  virtually  the  same 
in  all  persons.  According  to  Walker  Hall,  there  is  no  personal  equation 
in  this  metabolic  process.  It  is  known,  however,  that  all  purins  in  the 
food  are  not  absorbed.  There  is  a  normal  daily  excretion  of  purin  bodies 
in  the  feces  referred  to  as  fecal  purin,  to  distinguish  it  from  that  ex- 
creted by  the  kidneys  called  urinary  purin.  Of  course,  the  amount  of 
fecal  purin  varies  with  the  kind  of  food,  and  is  greater  where  substances 
are  eaten  which  are  rich  in  nuclein  and  purin  derivatives.  Ordinarily, 
60  per  cent  of  the  purin  bodies  are  absorbed  and  40  per  cent  excreted 
with  the  feces. 

PURIN  BODIES  IN  FOOD.— The  chief  fluctuation  in  the  amount  of 
tiric  acid  in  the  urine  can  be  explained  by  variations  in  the  amount  of  uric 
acid  yielders  (purins)  contained  in  the  food.     The  endogenous  fraction, 


334       SCIENTIFIC    FEEDING    OF   NITROGEN    FOODS 

on  the  other  hand,  seems  to  be  thoroughly  fixed,  but  as  to  its  exact  seat 
and  mode  of  formation  and  the  precise  conditions  which  control  it,  we  still 
have  much  to  learn.  It  is  obvious  that  we  have  at  hand  an  important 
means  of  regulating  the  amount  of  uric  acid  liberated  in  the  body,  namely 
by  controlling  the  amount  of  purins  in  the  dietary.  As  stated,  the  foods 
which  yield  much  uric  acid  are  the  cellular  organs  of  animals.  We  have, 
then,  a  clear  dietetic  indication  if  we  wish  to  lessen  the  liberation  of  uric 
acid  in  the  body.  The  diet  recommended  is  one  composed  largely  of 
vegetables  with  the  exception  of  oatmeal,  beans,  peas,  onions  and  asparagus. 
Below  we  append  a  table  from  Tibbies  (4)  of  the  various  foodstuffs, 
showing  the  percentage  of  purins  contained,  which  are  to  be  tabooed  if 
we  wish  to  lessen  the  manufacture  of  uric  acid  in  a  patient. 


THE  QUANTITY  OF 

PURINS  IN  FOOD 

Varieties  of  Food 

Purins,  grains 
per  pound 

Percentage 
of  purins 

Codfish 

4.07 
5.56 
7.14 
8.15 
4.00 
6.75 
8.14 
8.49 
3.97 
8.08 
7.96 
9.13 
14.45 
19.26 
70.43 
9.06 
8.82 
6.31 
3.45 
2.54 
4.16 
.14 
.26 
1.50 
1.09 
1.27 
1.35 

.058 

Plaice 

079 

Halibut 

102 

Salmon 

.116 

Tripe         

057 

Mutton 

.096 

Veal :  Loin 

116 

Pork :  Loin 

.121 

Neck 

.056 

Ham  (fat) 

.115 

Beef:  Ribs 

.113 

Sirloin 

.130 

Steak 

.206 

Liver 

.275 

Sweetbread 

1.006 

Chicken 

.129 

Turkey 

.126 

Rabbit 

.097 

Oatmeal 

.053 

Peameal 

039 

Haricot  beans 

063 

Potatoes 

.002 

Onions 

.009 

Asparagus 

.021 

Lager  beer 

.012 

Pale  ale 

.014 

Porter 

015 

EFFECT  OF  PURIN  FOODS  ON  URIC  ACID.— The  effect  of  purin 
foods  on  the  uric  acid  content  of  the  blood  has  recently  been  studied  at 
length  by  W.  Denis (5),  who  concludes  that  "in  normal  individuals  no 


PROTEIN    METABOLISM  335 

increase  in  the  circulating  uric  acid  is  produced  by  the  ingestion  of  even 
large  quantities  of  purins.  The  ingestion  of  purins,  either  free  as  they 
occur  in  meats,  or  in  the  form  of  nucleoproteins  of  glandular  tissues  like 
liver,  sweetbread,  etc.,"  is  followed  by  a  decided  increase  in  the  urinary 
output  of  uric  acid.  Denis  concludes  that  the  normal  kidney  reacts  to  an 
excess  of  uric  acid  in  a  way  essentially  similar  to  that  which  it  conducts 
itself  to  an  excess  of  urea,  and  is  able  to  excrete  the  excess  of  uric  acid 
presented  to  it  when  a  diet  high  in  purins  is  fed,  thereby  keeping  the  cir- 
culating uric  acid  at  the  same  level  as  that  obtained  when  only  endogenous 
uric  acid  is  to  be  excreted.  When  the  kidney  has  been  damaged,  even 
before  certain  damage  has  reached  the  point  where  nitrogen  retention  is 
apparent,  as  shown  by  the  non-protein  nitrogen  values,  an  accumulation 
of  uric  acid  takes  place  in  the  blood  after  a  short  period  of  purin  feeding. 
This  phenomenon  is  interesting,  not  alone  from  the  evidence  that  it  brings 
of  the  importance  of  the  renal  efficiency  for  the  level  at  which  uric  acid 
circulates  in  the  blood,  but  also  for  its  value  to  diagnostic  procedures. 
Denis  suggests  that  when  the  determination  of  uric  acid  in  the  blood  is 
undertaken  for  diagnostic  purposes,  the  insistence  for  a  short  period  of 
purin-free  foods  is  unnecessary,  except  in  cases  in  which  kidney  insuf- 
ficiency exists,  or  perhaps  in  the  case  of  persons  who  habitually  consume 
extremely  large  quantities  of  foods  of  a  high  purin  content. 

There  are  two  views  as  to  the  origin  of  uric  acid:  (a)  that  it  is  formed 
in  the  kidneys;  (b)  that  it  is  formed  in  the  tissues.  The  view  that  uric 
acid  is  formed  in  the  kidneys  as  well  as  excreted  by  them  was  taught  by 
Garrod  as  early  as  1848,  who  was  able  to  show  that  the  blood  of  gouty 
persons  contained  abnormal  quantities  of  uric  acid,  which  observation  has 
since  been  confirmed  by  many  observers. 

KXCKSS  OF  PURIN  DIET.— The  continuous  consumption  of  food  con- 
taining purin  bodies  in  large  percentage  ultimately  leads  to  their  accumu- 
lation and  retention  in  the  organism,  when  renal  insufficiency  supervenes. 
The  normal  liver  can  transform  and  the  kidneys  can  excrete  purin  bodies 
so  long  as  these  organs  are  executing  their  normal  functions,  and  no 
accumulation  will  result,  but  there  is  always  danger  that  the  constant  irri- 
tation of  the  kidneys  by  the  excess  of  purin,  more  especially  uric  acid, 
may  result  in  chronic  nephritis  of  the  gouty  type.  Renal  insufficiency, 
with  the  retention  of  purins  in  the  system,  it  is  thought,  may  be  the  cause 
of  gout,  but  its  etiological  relation  to  so-called  rheumatic  gout,  uric  acid 
gravel,  uric  acidemia,  migraine,  neuralgia,  sciatica,  epilepsy,  vascular  dis- 
eases and  many  other  conditions  of  ill  health  in  which  it  has  been  put  forth 
as  a  causative  factor,  is  very  doubtful. 


336       SCIENTIFIC    FEEDING    OF    NITROGEN    FOODS 

PURIN-FREE  DIET. —  Furin-free  diet  is  indicated  iu  gout  and  wherever 
it  is  desirable  to  reduce  renal  irritation.  The  foods  enumerated  in  the  table 
on  page  334  should  be  interdicted  and  the  following  foods,  which  contain 
practically  no  purin,  advised :  milk,  cheese,  cream,  butter,  eggs,  white 
bread,  macaroni,  rice,  sago,  tapioca,  cabbage,  cauliflower,  lettuce,  water- 
cress, fruit,  sugar,  honey,  marmalade,  jam,  jelly,  sherry,  port,  volnay.  and 
claret.  Four  articles  of  diet — -milk,  butter,  eggs  and  cheese — form 
together  our  most  valuable  means  of  withholding  purin  substances  from  the 
body  and  yet  allowing  the  intake  of  a  diet  at  once  digestible,  easily  ab- 
sorbed and  capable  of  maintaining  nitrogenous  equilibrium.  It  is  a  milk 
and  fruit  diet  with  bread  and  butter,  milk  puddings  and  salads  added  to 
it.  Milk  and  milk  products  contain  only  traces  of  purin.  Potatoes  and 
onions  contain  very  little,  and  are  allowed.  Oatmeal,  peameal  and  malted 
lentils  contain  from  21/0  to  31/2  grains  of  purins  per  pound,  and  should 
not  be  allowed.  Asparagus  contains  very  little  purin,  but  much  asparagin, 
which  is  a  valuable  protein-sparer.  The  following  articles  should  be  alto- 
gether forbidden :  tea,  cofi^ee,  cocoa,  kola,  guarana,  fish,  fowl  and  butcher's 
meat,  brown  bread,  peas,  beans,  asparagus,  ale,  stout  and  lager  beer. 
Cider,  perry  and  a  small  quantity  of  spirits,  claret,  sherry  or  volnay,  may 
also  be  allowed.  Wines  do  not  appear  to  contain  any  purin  bodies  and 
their  harmful  properties  in  gout  must  be  due  to  some  other  constituent. 

The  purin  bodies  in  coffee,  tea  and  chocolate  are  largely  methyl-purin, 
and  do  not  undergo  the  same  metabolic  changes  as  other  purins,  so  they 
need  not  be  excluded  from  the  diet  of  the  gouty  or  rheumatic  as  rigorously 
as  other  purins. 

Dr.  Alexander  Haig  is  authority  for  the  following  purin-free  diet, 
which  yields  about  90  grams  of  protein,  enough  to  meet  the  daily  re- 
quirement : 

PURIN-FREE  DIET  TO  SUPPLY  PROTEIN 

12  ounces  of  white    bread  contain 372  grains  25     grams 

4       «       "  oatmeal    "  "      208      "  14         " 

2  "       "  rice  «      86      "  5.6      " 

3  pints  of  milk  "      572      "  38.1       " 

16  ounces  of  vegetables  and  fruit  contain 140      "  9.3      " 

LOW-PURIN  DIET.— A  low-purin  diet  consists  of  the  same  articles  of 
food  mentioned  in  the  purin-free  diet,  with  the  following  additions :  tripe, 
codfish,  potatoes,  onions  and  particularly  all  fruits  and  green  vegetables. 
Puddings  may  be  made  of  milk,  sugar,  eggs,  rice,  sago,  tapioca  and  maca- 
roni or  flour,  and  custard,  junkets,  jellies  and  suet  may  be  used. 


PEOTEIN    METABOLISM  337 

One  of  Haig's  disciples  suggests  the  following  for  purin-f ree  meals : 

First  Day 

Lunch: 

Green  vegetables,  baked  potatoes,  butter,  stewed  figs,  J^  pint  of  junket,  2  ounces 
of  pine  nut  kernels  (grated),  with  whipped  cream. 

Dinner: 

Biscuits  and  butter,  1  ounce  of  grated  cheese  or  some  milk  curds,  light  pudding, 
stewed  fruit  and  cream. 

Second  Day 

Lunch: 

Green  vegetables,  potatoes  with  butter,  cheese  sauce  and  dry  toast,  fruit  tart 
with  cream,  3^  pint  of  milk. 

Dinner: 

Two  boiled  eggs,  biscuits  and  butter,  milk  pudding  containing  3^  pint  of  milk, 
stewed  fruit  and  cream  with  biscuits. 

Third  Day 
Lunch: 

Potatoes  and  butter,  green  vegetables  or  salad,  pudding  or  "cutlet"  made  of  two 
ounces  of  ground  nuts,  stewed  fruit  and  cream  with  biscuits. 

Dinner: 

Biscuits  and  butter,  with  cheese  souffle  or  omelette,  stewed  fruit  and  cream  with 
biscuits,  roasted  chestnuts. 

It  must  be  realized  that  a  purin-free  diet  is  only  a  temporary  measure. 
A  purin-free  diet  is  at  best  only  a  low  protein  diet,  and  the  physician 
must  see  that  the  proteins  consumed  do  not  fall  below  60  or  70  grams 
per  day.  This  diet  should  not  be  continued  longer  than  two  or  three 
months  before  fish,  tripe,  pork  and  ham  are  allowed.  Part  of  the 
meat  bases  and  purins  will  be  washed  out  during  the  boiling  of  these 
foods.  It  is  claimed  by  some  dietitians  that  the  first  meat  allowed  should 
be  sweetbread,  because  the  purins  in  it  are  "bound-purins."  Equally 
competent  observers.  Walker  Hall,  Burian  and  Schurr,  and  Tibbies,  do  not 
favor  the  allowance  of  sweetbread  for  the  reason  that,  on  analysis,  it  shows 
a  very  high  percentage  of  purins.  These  observers  find  that  from  60  to 
70  per  cent  of  those  purins  are  absorbed  and,  at  the  most,  only  40  per  cent 
escape  absorption.  It  is  advisable,  when  an  ordinary  diet  is  resumed,  to 
make  additions  gradually.  First  allow  boiled  leg  or  loin  of  mutton,  boiled 
rabbit  or  boiled  fowl,  as  the  breast  of  fowl  contains  less  extractives  than 
the  other  portions.  The  physician  can  conservatively  allow  pigeon,  breast 
of  turkey  or  other  fowl,  well  roasted  rib  of  beef,  sirloin  of  beef  and  steak, 
the  latter  being  added  last.  The  following  articles  of  food  should  be  per- 
manently excluded :  veal,  pork,  except  the  neck,  goose,  duck,  high  game 
and  greasy  foods.  The  question  has  been  asked :  "Is  a  purin-free  or  a  low- 
purin  dietary  useful  in  the  treatment  of  gout  ?"    Most  certainly  it  is.    If 


338       SCIENTIFIC    FEEDING    OF    NITROGEN    FOODS 

gout  be  due  to  the  defective  metabolism  of  nuclein  or  accumulation  of 
purin  bodies  from  renal  insufficiency,  these  substances  should  certainly 
be  excluded  from  the  diet  imtil  the  organism  recovers  its  powers  of  elimi- 
nating them.  The  diet  doubtless  has  its  limitations.  It  is  not  a  panacea, 
and  in  gout  its  use  is  limited  by  the  nature  of  the  disease. 

Fat-free  Diet. — A  fat-free  diet  is  of  value  in  hypochlorhydria,  catarrh, 
atony  and  dilatation  of  the  stomach  and  in  carcinoma  of  the  stomach. 
For  some  time  it  has  been  known  that  the  presence  of  an  excess  of  fat, 
particularly  of  butter,  in -the  contents  of  the  stomach,  will  check  the  secre- 
tion of  gastric  juice,  and  advantage  has  been  taken  of  this  fact  in  the 
treatment  of  hypochlorhydria.  On  this  account,  the  absence  of  fat  from 
food  allows  a  more  generous  secretion  of  gastric  juice,  including  hydro- 
chloric acid.  In  various  disorders  of  the  stomach,  a  condition  of  hypo- 
chlorhydria exists,  where  the  normal  proportion  of  hydrochloric  acid  is 
absent,  in  consequence  of  which  the  mucous  membrane  of  the  stomach  may 
become  infected  by  microorganisms,  which  give  rise  to  catarrh,  organic 
acidity,  atony  of  the  muscular  coat,  and  dilatation.  In  carcinomatous 
conditions  of  the  stomach,  near  the  pylorus,  there  is  likewise  a  diminu- 
tion of  free  hydrochloric  acid,  and  some  authorities  consider  the  cachexia 
produced  by  this  disease  a  consequence  of  the  subnutrition  resulting  from 
hypochlorhydria.  It  is  argued  that  the  elimination  of  fat  from  the  di- 
etary encourages  a  freer  secretion  of  gastric  juice  with  a  larger  propor- 
tion of  free  hydrochloric  acid,  and  the  normal  (nascent)  hydrochloric 
acid  comes  into  direct  contact  with  the  crypts  of  the  mucous  membrane, 
which  it  slowly  but  effectively  disinfects,  and  at  the  same  time  gives  tone 
to  the  muscular  coat.  A  fat-free  diet  is  of  value  in  such  conditions.  On 
the  opposite  page  we  give  a  table  of  fat-free  foods,  foods  containing  0.5 
per  cent,  foods  containing  less  than  1  per  cent  of  fats,  and  foods  with  1  to 
2  per  cent  of  fat. 

It  is  practically  impossible  to  provide  an  absolutely  fat-free  diet. 
However,  we  can  get  near  enough  to  a  fat-free  diet  by  removing  as  much 
fat  as  possible  from  the  meat  and  milk  and  avoiding  the  use  of  butter, 
suet  and  other  fats  and  oils.  The  table  will  serve  as  a  guide  to  the  phy- 
sician or  dietitian  in  directing  a  practically  fat-free  diet  which  would 
consist  largely  of  bread,  marmalade,  white  of  eggs,  meat  extracts,  soups, 
broths,  oysters,  light  fish,  lean  meat  and  the  breast  of  fowl,  potatoes, 
vegetables  and  fruits. 

Carbohydrate-free  Diet. — A  carbohydrate-free  diet  is  one  practically 
consisting  of  meat,  gTeen  vegetables  and  hot  water.  A  diet  free  from 
starch,  sugar  and  other  carbohydrates  is  recommended  in  the  treatment 


PROTEIN    METABOLISM 
PERCENTAGES  OF  FAT  IN  FOODS 


339 


Ti^af-frpo  T^^noH^ 

Foods  containing  0.5 

Foods  containing  less 

Foods  with  1  to  2 

J.  Cl\j    Lx  v>L/    J.  WI^V.aO 

per  cent  or  less 

than  1  per  cent  of  fat 

per  cent  of  fat 

Sugar 

Skim  milk 

Fine  white  flour 

Sole,  plaice 

Honey 

Casein  powders 

White  bread 

Smelt 

Treacle 

Sugar,  pears 

Ryemeal 

Sturgeon 

Starch 

Corn-starch 

Rye  bread 

Weakfish 

Dextrin 

Arrowroot,  sago 

Beef  tea 

Skate 

Beef  tea 

Apples,  tapioca 

Meat  extracts 

Bluefish 

Meat  extracts 

Green  peas 

Beef  broth 

Blackfish 

Casein  preparations 

String  beans 

Meat      stews      when 

Kingfish 

Potatoes,  Litchi  nuts 

skimmed 

Venison 

Parsnips,  muskmelons 

Tomato  soup 

Partridge 

' 

Can-ots,  turnips 

Oxtail  soup 

Breast  of  boiled  fowl 

Radishes,  watei-meloas 

Mulligatawny  soup 

Wheat 

Beetroot,  salsify 

Pea  soup.  Gumbo  soup 

Brown  bread 

Scorzonera 

Turtle,  frog's  legs 

Wholemeal  bread 

• 

Cabbage,  plums 

Oysters,  clams 

Buckwheat  flour 

Cauliflower 

Scallops 

Macaroni 

Brussels  sprouts 

Crab,  Crayfish 

Vermicelli 

Spinach,  currants 

Shrimps 

Haricot 

Vegetable  marrow 

Fish: 

Navy  beans 

Squash,  lettuce 

Bass,  cod 

Dried  peas 

Asparagus,  oranges 

Cusk,  flounder 

Frijoles 

Tomatoes,  peaches 

Haddock,  hake 

Green  com 

Muslirooms,  truffles 

Yellow  perch 

Grapes 

Onions,  melons 

Perch-pike 

Bananas 

Leeks,  cucumbers 

Gray  pike 

Celery,  rhubarb 

Pickerel-pike 

Strawberries 

Pollock 

Raspberries 

Red  grouper 

Gooseberries 

Red  snapper 

White  of  eggs 

of  certain  gastric  ailments,  rheumatism,  gout,  diabetes  and  uric  acidemia. 
Dr.  Salisbury  first  recommended  this  form  of  diet,  and  according  to  his 
directions  it  consists  of  from  two  to  four  pounds  of  beef  freed  from  fat, 
gristle,  connective  tissue  and  bone.  It  is  chopped  very  fine,  made  into 
patties  about  three  inches  in  diameter  and  one  inch  thick,  and  fried  in 
a  pan  without  fat  or  water.  These  are  heated  rapidly  on  one  side  and 
then  on  the  other  to  coagulate  the  albumin,  after  which  the  process  of 
cooking  is  allowed  to  proceed  very  slowly,  and  they  are  served  while 
slightly  underdone.     (See  Volume  II,  Chapter  XII.) 

Cellulose  Diet — The  cellulose  diet  furnishes  nutritive  subsistence  for 
the  lower  animals,  the  herbivora  being  able  to  digest  from  60  to  TO  per 
cent  of  the  crude  fiber  of  dried  gi'asses  (hay)  and  cereals ;  47  to  62  per 
cent  of  that  in  carrots,  cabbage  and  celery,  and  25  per  cent  of  that  in 


340      SCIENTIFIC   FEEDI:NG    OF    NITROGEX    FOODS 

lettuce.  It  is  within  the  bounds  of  probability  that  primitive  man  pos- 
sessed this  faculty  in  common  with  herbivorous  animals.  It  is  stated  by 
competent  authority  that  at  the  present  day  some  of  the  existing  primitive 
races,  the  Bushman,  ]!s^ilotic  negro,  and  others,  possess  a  very  large  cecum, 
and  that  their  colon  secretes  an  enzyme  which  dissolves  the  outer  covering 
of  vegetable  cells,  and  the  fluid  from  the  vermiform  appendix  digests 
cellulose.  The  civilized  races  of  mankind  have  lost  the  power  of  digesting 
cellulose  material.  Bunge  is  authority  for  the  assertion  that  "the  epi- 
thelium of  the  colon  secretes  an  enzyme  which  has  a  slight  action  on  the 
cellulose  coverings  of  cells";  notwithstanding,  he  practically  agrees  with 
the  majority  of  clinicians  that  putrefaction  is  practically  the  only  change 
which  cellulose,  or  crude  fiber,  undergoes  in  the  intestines  of  man,  and 
that  its  principal  and  only  use  in  the  human  economy  is  a  mechanical 
stimulus  to  peristalsis.  Cellulose  undoubtedly  possesses  irritating  quali- 
ties which  it  is  necessary  to  minimize  in  cases  of  chronic  gastric  and  in- 
testinal catarrh,  ulcer  of  the  stomach,  cancer  or  stricture  of  the 
pylorus.  Physiologists  tell  us  that  the  presence  of  cellulose  acts  as  a 
stimulant,  and  as  a  result  the  food  is  hurried  along  in  the  alimentary 
canal  more  rapidly  than  wben  this  substance  is  absent.  This  irritating 
effect  is  desirable  in  cases  of  atony  of  the  intestinal  canal,  and  advantage 
should  be  taken  of  it  in  prescribing,  while  the  conclusion  to  be  drawn 
from  the  observations  of  Bunge  and  others  is  that  the  advantages  arising 
from  the  presence  of  cellulose  in  the  food  of  the  average  individual  will 
far  outweigh  its  disadvantages. 

Von  Noorden  prescribes  a  whole-meal  Graham  bread,  all  sorts  of 
legumes,  including  the  skins,  coarse  oatmeal  and  vegetables  containing  a 
high  percentages  of  cellulose,  fruits  having  thick  skins  and  large  quantities 
of  butter,  bacon  and  ham.  In  cases  of  chronic  constipation,  and  especially 
those  complicated  with  mucous  colitis,  he  claims  that  this  diet  permanently 
cures  50  per  cent  of  all  cases  and  that  28  per  cent  are  probably  improved 
or  partially  cured. 

The  following  foods  contain  considerable  cellulose  and  are  recom- 
mended as  adjuvants  to  the  diet  for  the  relief  of  chronic  constipation: 
wholemeal  bread  of  any  description,  eaten  with  plenty  of  butter,  fat  ham, 
bacon,  treacle  or  marmalade ;  fat  meat,  bacon  or  ham  for  dinner,  with  a 
large  proportion  of  dried  peas,  cabbage,  savoy,  lentils,  Brussels  sprouts, 
cauliflower,  one  or  two  eggs  daily,  poached,  buttered  or  scrambled  in  pref- 
erence; turnips,  parsnips,  onions,  okra,  swedes,  seorzonera  and  leeks. 
Dessert  should  consist  of  raw  or  cooked  fruit,  pears,  strawberries,  cur- 
rants, apples,  grapes,  raspberries,  gooseberries,  loganberries,  blackberries, 


MINERAL    METABOLISM  341 

whortleberries  and  cranberries.  Plenty  of  cream  should  be  taken  with 
cooked  fruit.  Sugar  is  allowed.  Apples,  apricots,  plums,  peaches  and 
acid  fruits  in  general  also  stimulate  peristalsis  by  means  of  their  organic 
acids.  Oatmeal  is  of  great  value.  The  coarse  meal  is  the  best  form,  but 
oat-cakes  and  groats  may  also  be  eaten.  Barley  bread,  pearly  barley, 
buckwheat  cakes  and  rye  bread  are  useful. 

MINERAL   METABOLISM 

The  salt  metabolism  of  disease  is  a  most  important  subject.  Few 
studies  of  the  balances  of  the  various  salts  in  disease  have  as  yet  been 
made  at  the  hands  of  biochemists,  but  the  therapy  of  the  future  will  un- 
doubtedly include  the  practical  application  of  salt  metabolism  to  the  prin- 
ciples of  nutrition.  Wellman,  who  has  given  some  thought  to  this  sub- 
ject, finds  that  there  was  a  greater  loss  of  salts  in  fasting  than  was 
accounted  for  by  the  metabolism  of  the  fleshy  portion  of  the  body.  The 
principal  loss  was  phosphorus  pentoxid  and  calcium  and  magnesium  oxids, 
in  about  the  same  proportion  as  contained  in  bone;  and  the  skeletons  of 
animals  were  found  to  have  actually  lost  from  6  to  7  per  cent  of  their 
weight.  In  many  diseased  conditions,  there  was  present  a  lowered 
calcium  excretion;  for  instance,  in  pleurisy  with  effusion,  pneumonia, 
delirium  tremens,  and  in  typhoid  and  malarial  fevers.  Senator,  in  writ- 
ing on  this  subject,  said  that  there  was  in  pulmonary  tuberculosis  an  excess 
of  calcium  excretion.  In  osteomalacia  the  calcium  balance  is  also  dis- 
turbed, more  being  excreted  than  is  taken  into  the  body.  The  calcium 
excretion  is  lessened  by  phosphoric  acid,  which  fact  might  be  of  use  in 
experimental  therapeutics.  It  is  said  that  castration  restores  the  CaO 
equilibrium,  which  also  influences  the  restoration  of  sulphur  equilibrium. 
In  myostitis  ossificans,  on  the  other  hand,  the  calcium  output  is  less  than 
normal.  In  arthritis  deformans  there  is  a  retention  of  lime  salts.  Also 
in  endarteritis  the  excretion  of  calcium  is  hindered  and  one  observer  even 
claims  to  have  obtained  good  results  by  the  administration  of  salts,  viz., 
lactic  acid,  sodium  lactate,  sodium  citrate,  sodium  carbonate  and  sodium 
chlorid,  which,  according  to  his  contention,  aid  in  the  excretion  of  calcium. 
It  is  probably  unsafe  to  assume  that  a  diet  containing  sufficient  protein 
and  energy  necessarily  furnishes  sufficient  calcium  and  other  salts  for  the 
metabolism  of  the  body.  This  point  can  only  be  settled  by  metabolism 
experiments  in  which  a  balance  is  made  between  the  intake  and  the  output. 
The  most  recent  investigation  and  thorough  research  into  this  subject  has 
been  made  by   Sherman,  Mettler  and   Sinclair(6).      Space  forbids   an 

122 


342       SCIENTIFIC    FEEDi:NrG    OF    JsHTROGEN    FOODS 

extended  review  of  their  interesting  experiment,  but  the  table  below  ^ 
shows  the  average  amount  of  calcium,  magnesium,  phosphorus  and  iron 
consumed  daily  in  the  various  dietaries. 

THE  MINERALS  IN  TYPICAL  DIETARIES:  DAILY  QUANTITIES  PER  MAN 


Subjects  of  the  Study 


Fuel 

Iron 

(Fe) 
(Gms.) 

Phos- 

Cal- 

Value 

Protein 

phoric 

cium 

(Calo- 

(Gms.) 

acid 

oxid 

ries) 

(Gms.) 

(Gms.) 

6,780 

179 

.035 

5.88 

1.27 

3,260 

123 

.021 

3.97 

1.09 

3,595 

123 

.019 

4.05 

1.22 

3,305 

112 

.019 

3.44 

.90 

3,545 

108 

.021 

3.53 

1.15 

2,780 

106 

.016 

3.64 

1.42 

3,180 

102 

.017 

3.92 

1.69 

4,060 

97 

.017 

3.58 

.90 

2,820 

95 

.019 

3.56 

.83 

3,085 

94 

.016 

2.73 

.49 

3,280 

91 

.015 

2.82 

.83 

3,330 

85 

.015 

2.88 

.97 

2,325 

84 

.014 

2.41 

.47 

2,525 

83 

.013 

2.40 

.50 

4,955 

80 

.012 

3.25 

.21 

2,440 

77 

.012 

1.52 

.40 

2,430 

71 

.012 

2.27 

.50 

3,560 

66 

.011 

2.08 

.46 

1,500 

54 

.009 

1.84 

.68 

2,240 

44 

.007 

2.05 

.08 

Mag- 
nesium 

oxid 
(Gms.) 


Maine  lumbermen 

School  superintendent's  family, 
Chicago 

Students'  Club,  University  of  Ten- 
nessee  

Decorator's  family,  Pittsburgh 

Farmer's  family,  Connecticut 

Teacher's  family,  Indiana 

Teacher's  family.  New  York  City . 

Mechanic's  family,  Tennessee 

Farmer's  and  mechanic's  famihes, 
Tennessee 

Glass-blower's  family,  Pittsburgh. 

Lawyer's  family,  Pittsburgh 

Women  Students'  Club,  Ohio 

Lawyer's  family.  New  York  City.. 

Laborer's  family,  Pittsburgh 

Negro  family,  Alabama 

Laborer's  family,  Pittsburgh 

Laborer's  family,  New  York  City.. 

Farm  Students'  Club,  Tennessee.  . 

Sewing-woman's  family,  New  York 
City 

Very  poor  negro  family,  Alabama . 


1.21 

.55 

.63 
.48 
.55 
.44 
.54 
.72 

.59 
.36 
.40 
.67 
.30 
.34 
.74 
.19 
.29 
.34 

.23 
.52 


Tachau(7),  who  has  done  much  experimental  work  in  salt  metabolism, 
holds  that  the  catabolism  of  easily  burned  carbohydrates  often  furnishes 
too  much  heat.  Then,  unless  the  "windows  are  opened,  the  house  may  get 
too  warm,"  or  they  may,  in  too  large  quantities,  be  incompletely  burned 
and  thereby  produce  substances  which  will  seriously  interfere  with  the 
protoplasm  (cellular)  chemical  processes  (cellular  asphyxia).  The  split 
products  of  both  fats  and  carbohydrates  may  indeed  menace  the  body,  and 
the  lack  or  overabundance  of  the  mineral  salts  may  surely  tend  to  change 
the  reactions  of  the  living  cells. 

If  the  results  of  experiments  are  correctly  interpreted,  we  find  that 


1  From  Bull.  227,  Exp.  Sta.,  V.  S.  Dept.  Agric. 


MINERAL    METABOLISM  343 

the  "living  organism  may  be  regarded  as  a  liiglily  nnstable  chemical  sys- 
tem which  tends  to  increase  itself  continuously  under  the  average  of  the 
conditions  to  which  it  is  subject;  it  undergoes  disintegration  as  a  result 
of  any  variation  from  this  average"(8).  With  the  lights  before  us,  tliere 
is  no  reason  to  charge  any  harmful  results  to  starch  itself.  "It  is  only 
when  ingested  in  excessive  amounts  for.  long  periods  of  time  that  harm 
results,  and  this  is  due  not  so  much  to  the  starch  as  to  the  attendant  depri- 
vation of  other  foodstuffs,  protein,  hydrocarbons  and  organic  mineral 
matter" (9).  If  an  animal  is  allowed  a  liberal,  well-balanced  dietary,  con- 
sisting of  protein,  fats,  carbohydrates  and  water  with  no  organic  mineral 
salts,  it  will  die  more  quickly  than  if  it  received  no  food  at  all (10).  For 
this  reason,  the  importance  of  salts  has  been  extensively  dwelt  upon  (see 
Volume  1,  Chapter  IX,  Volume  II,  Chapter  VIII)  by  various  workers, 
but  no  one  has  shown  in  simpler  way,  or  a  more  convincing  form,  the 
reasons  for  the  value  of  salts  in  the  economy  than  Fischer  (11).  "The 
great  importance  of  the  organic  mineral  salts  in  the  human  organism  is 
due  to  their  effects  upon  the  physical  condition  of  the  proteins  of  the 
body.  It  is  true  they  furnish  practically  no  energy  and  yet  are  essential." 
Schaefer(12)  has  said  that  "the  chemistry  and  physics  of  the  living 
organism  are  essentially  the  chemistry  and  physics  of  the  nitrogenous 
colloids,"  and  Guyer(13)  voiced  the  opinion  that  what  we  call  protoplasm 
is  really  an  aggregate  of  colloids,  holding  water  for  the  most  part,  in 
which  are  contained  certain  salts  and  non-electrolytes. 

Electrolytic  Properties  of  Salts — Water  forms  a  large  percentage  of  the 
substance  of  the  cell,  and  is  essential  for  its  existence  as  providing  the 
medium  wherein  those  chemical  processes  which  constitute  metabolism 
take  place.  This  medium  is  a  dilute  solution  of  sodium  chlorid  in  which 
the  molecule  of  the  salt  has  become  dissociated  into  its  free  constituents 
or  ions — sodium  and  chlorin.  These,  charged  respectively  with  negative 
and  positive  electricity,  are  what  are  termed  cath-ions  and  an-ions. 

These  ions  act  as  independent  particles  and  by  means  of  their  powers 
of  electric  attraction  and  repulsion  are  the  forces  which  directly  cause 
bodily  chemical  changes.  The  presence  of  salts  in  the  .cells  and  their  con- 
dition of  dissociation  or  ionization  are  matters  of  great  practical  interest, 
because,  in  the  first  place,  as  regards  the  very  ordinary  salts,  the  phe- 
nomena of  endosmosis  and  exosmosis  are  largely  due  to  their  presence  in 
the  cell,  and  also  because  the  protein  molecules  only  manifest  their  activity 
in  a  dilute  saline  solution  under  the  conditions  of  ionization  therein. 

These  salts,  it  seems,  are  of  inestimable  value,  because  they  change  the 
affinity  of  the  protoplasm  for  water,  so  that  at  one  time  when  there  is 


344       SCIENTIFIC    FEEDING    OF    NITEOGEN    FOODS 

relative  lack  of  salts  the  protoplasm  loses  water  and  at  another  time  it 
absorbs  water  and  with  it  food  materials.  Without  doubt,  the  salts  of  the 
foods  are  the  agents  which  control  to  a  large  extent  the  secretion  and 
absorption,  but  it  must  not  be  forgotten  that  the  formation  of  salts  enters 
into  the  regulation  of  neutrality  in  the  body;  but  that  is  only  a  part  of 
the  problem  of  secretion  and  absorption,  which  was  fully  considered  in 
Volume  I,  Chapters  VI  and  VII. 

Sodium  Chlorid. — The  importance  of  sodium  chlorid  in  the  diet  was 
considered  in  Volume  I,  Chapter  XI,  where  we  learned  that  it  "protects 
protein  substances  from  disassimilation,"  i.e.,  it  produces  assimilation, 
and  its  use  from  this  viewpoint  is  economical.  The  sodium  chlorid  con- 
tent of  the  body  is  of  great  importance  and  what  might  be  termed  sodium 
chlorid  equilibrium  is  maintained.  In  normal  individuals,  if  sodium 
chlorid  is  partaken  of  too  liberally,  there  is  an  increase  in  the  elimination, 
and  if  the  amount  is  partaken  of  sparingly  there  is  a  diminution  in  the 
output;  but  a  certain  amount,  about  2  grams  per  day,  must  be  partaken 
of  to  make  up  for  the  daily  loss.  Bunge  considers  the  presence  of  sodium 
chlorid  essential  to  prevent  the  toxic  effects  of  potassium.  There  is  no 
question  but  that  it  plays  an  important  part  in  the  nutritive  exchange 
between  the  cells  and  the  plasma  and  stimulates  the  excretion  of  waste 
products  by  the  kidneys.  Exclusion  of  common  salt  from  the  food  leads 
to  dehydration  of  the  tissues,  and  this  is  the  basis  of  the  salt-free  dietary. 
Salt  is  found  in  varying  quantities  in  all  foodstuffs,,  and  the  daily  require- 
ment is  from  15  to  20  grams.  The  presence  of  an  abnormal  amount  of 
sodium  chlorid  in  the  blood  and  tissues  is  one  of  the  causes  of  edema. 

The  amount  of  salt  consumption  per  capita  per  diem  for  the  Ameri- 
can people  is  more  or  less  an  unsettled  question,  since  medical  literature 
contains  no  statistics  on  the  question.  According  to  Archard  the  average 
consumption  of  salt  by  the  French  people  is  300  grains  per  day. 

According  to  United  States  Army  regulations,  the  allowance  for  the 
soldier  is  about  300  grains  daily,  which  is  practically  a  large  heaping  table- 
spoonful.  We  may,  therefore,  take  the  soldier's  allowance  as  a  criterion 
for  the  amount  used  by  the  American  people.  Physiologists  tell  us  that 
95  per  cent  of  the  salt  ingested  is  eliminated  unchanged  within  24  hours. 
Then,  of  the  300  grains  consumed  daily  by  the  average  American,  285 
grains  are  excreted  and  cast  out  of  the  body  as  foreign  material  as  rapidly 
as  the  organs  of  excretion  can  accomplish  the  task.  Can  this  large  excre- 
tion of  salt  be  carried  on  daily  for  years  with  impunity  ?  The  history  of 
salt-using  nations  leads  us  to  ask  the  question  :  If  something  is  transpiring 
that  may  make  them  the  unhealthiest  animals  in  existence,  since  daily 


MII^ERAL    METABOLISM  345 

repeated  exliaustion  of  glandular  organs  by  exosmosis  tends  to,  logically, 
and  practically  does  produce  the  very  condition  of  glandular  torpidity  that 
afflicts  mankind  i 

The  retention  of  sodium  chlorid  in  the  tissues  is  due  to  one  of  the 
following  causes:  (a)  the  kidneys  may  be  unable  to  excrete  it,  or  (6)  it 
forms  chemical  combination  with  the  cells.  According  to  some  authorities, 
this  combination  occurs  in  the  preliminary  stages  of  edema  when  the  cells 
become  saturated  with  water  and  the  chlorid  begins  to  accumulate  in  the 
surrounding  fluids.  Whether  this  explanation  is  satisfactory  or  not,  this 
much  is  known.  Marie  argues  that,  when  water  is  retained  in  the  tissues, 
it  requires  the  presence  of  sodium  chlorid  to  balance  the  osmotic  pressure 
of  the  salt  in  the  blood  {see  Volume  I,  Chapter  VII,  Osmosis  and  Diffu- 
sion).  The  greater  the  amount  of  water  retained  in  the  tissues  the  more 
sodium  chlorid  will  be  accumulated  therein,  and  the  less  will  be  excreted 
by  the  kidneys.  In  Bright's  disease,  for  instance,  where  the  kidneys  are 
unable  to  excrete  salt  even  when  diuresis  has  been  established,  it  has  be- 
come the  custom  of  clinicians  to  reduce  the  intake  of  common  salt  with  a 
view  of  relieving  the  kidneys  of  the  extra  work  of  excreting  it.  The  indica- 
tion, then,  for  a  salt-free  diet  is  where  there  is  failure  of  compensation 
characterized  by  diminution  in  the  excretion  of  water.  The  diseased  con- 
ditions in  which  it  has  been  found  beneficial  and  practical  to  withhold 
sodium  chlorid  are  dropsy  from  cardiac,  renal  or  hepatic  diseases,  obesity, 
diabetes  insipidus  and  epilepsy.  A  salt-free  diet  is  also  useful  in  chronic 
parenchymatous  nephritis  with  edema  or  dropsy,  and  granular  kidney 
when  there  is  a  failure  of  compensation. 

SALT-FREE  DIET. — In  selecting  foods  for  salt-free  diet,  it  is  nnneces- 
sary  that  it  should  be  absolutely  salt-free,  besides  it  is  almost  impossible 
to  prepare  food  quite  free  from  it.  The  table  on  page  346  shows  the  per- 
centage of  sodium  chlorid  in  raw  and  cooked  foods,  taken  largely  from  an 
article  by  H.  Strauss  (14)  on  the  best  method  of  reducing  the  amount  of 
salt  in  the  diet : 

In  selecting  articles  of  food  for  a  rigid  salt-free  diet,  an  attempt 
should  be  made  to  keep  the  amount  of  sodinm  chlorid  down  to  between  li/o 
to  2  grams  per  day,  which  will  mean  the  exclusion  or  reduction  of  the 
allowance  of  meat,  fish  and  meat  broths.     According  to  Tibbies  (4)  : 

The  proteins  should  be  derived  from  milk,  eggs,  chicken  cooked  without  salt, 
tripe,  fresh-water  fish,  cheese  made  without  salt,  and  bread  made  without  salt. 
Milk  can  be  taken  alone  or  with  eggs,  in  the  form  of  custard,  in  puddings  with 
rice,  sago,  oatmeal,  etc.  Eggs  can  be  taken  in  many  ways  without  the  addition  of 
salt — e.g.,  custards,  milk  puddings,  poached  eggs,  boiled  eggs,  omelettes;  the  latter 


346       SCIENTIFIC    FEEDING    OF    NITROGEN    FOODS 

can  be  seasoned  with  sugar  instead  of  salt.  Eggs  can  also  be  taken  in  "cream," 
souffles  and  sauces.  Jellies  made  of  gelatin  or  isinglass  and  meat  jelly  are  permis- 
sible. The  fats  should  be  derived  from  milk,  eggs,  unsalted  butter,  fat  meat  eaten 
without  salt,  cheese  made  without  salt,  cream  cheese  and  salad-oil.  Carbohydrates 
may  be  obtained  from  sugar,  treacle,  golden  sirup,  jam,  marmalade,  bread  made 
without  salt,  milk  puddings  without  butter,  blane  mange,  jelly,  milk  sauces,  fruit 
and  vegetables.  Bread  and  pastry  made  without  salt  are  not  unpleasant  when 
eaten  with  stewed  fruit,  jam,  marmalade  and  unsalted  butter.  Vegetables  should 
be  allowed  ad  libitum,  because  they  can  be  made  the  vehicle  of  flour  and  fat  in  the 
form  of  "white  sauce."  It  is  recommended  that  all  vegetables  should  be  cooked  in 
plenty  of  water,  with  a  minimum  of  salt,  thereby  reducing  the  proportion  of  in- 
organic constituents.  No  salt  must  be  used  when  cooking  or  eating  the  food,  except 
the  small  amount  absolutely  necessary  to  give  flavor  to  potatoes,  cabbages  and 
other  green  vegetables,  and  the  salt  must  be  put  into  the  process  of  diffusion.  The 
absence  of  flavor  may  be  obviated  to  a  great  extent  by  a  careful  employment  of 
spices,  condiments  such  as  mint,  thyme,  parsley,  marjoram,  savory,  bay-leaf,  chut- 
ney, horseradish  sauce,  tomato  sauce,  mustard,  nutmeg,  cinnamon,  allspice,  va- 
nilla, lemon,  cocoa,  chocolate  and  coffee,  and  in  some  cases  a  small  amount  of 
pickles,  such  as  red  cabbage,  onion  or  cauliflower.  The  liquids  allowed  are  milk, 
whey,  buttermilk,  weak  tea,  cereal  or  fig  coffee,  lemonade,  fruit  juice  and  aerated 
waters,  or  a  small  amount  of  wine  or  spirit  and  water. 

THE  PERCENTAGE  OF  SODIUM  CHLORID  IN  FOODS 


Raw  food 


Per  cent 


Cooked  foods 


Per  cent. 


Unsalted  butter 

Yolk  of  eggs 

Fruit,  not  more  than . 

Meat,  unsalted 

Vegetables  and  salads 
Cereals  and  legumes. . 

Milk 

Eggs 

White  of  eggs 

Salted  butter 

Cheese 

Caviar 


.02 

.02 

.06 

.10 

.10 

.Ol-.IO 

.15-.18 

.14 

.19 

1.00 

1.5-2.5 

6-7 


Poached  eggs 

Fruit,  usually  less  than 

White  bread 

Brown  bread 

Cauliflower 

Cabbage 

Mashed  potato 

Roast  beef 

Beef  steak 

Buttered  eggs 

Omelettes 

Asparagus 


.5 

.5 

.48-.07 

.75 

.5-.9 

.5-.9 

.5-1.0 

1.9-2.8 

3.0 

2.4 

2.7 

2.7-3.5 


Moderate  variations  in  the  amount  of  salt  ingested  have  no  significant 
effect  upon  the  protein  metabolism.  Large  amounts  increase  the  quantity 
of  protein  catabolized,  and,  through  overstimulating  the  digestive  tract, 
may  also  interfere  with  the  absorption  and  utilization  of  the  food. 

Below  we  append  a  few  examples  of  diets  containing  not  more  than 
two  grams  of  salt  (Tibbies)  : 


MINERAL    METABOLISM  347 

(a)  Balint  prescribed:  Milk,  IH  to  2)^  pints;  butter,  13^  ounces;  three  eggs;   salt- 

less  bread,  9^  to  12)^  ounces,  and  weak  tea  or  coffee.    Calories,  2,300  to  2,400. 

(b)  Archard  and  Widal  drew  up  the  following  series  of  diets: 

(1)  Potatoes,  35  ounces;    meat,  10)^  ounces;    butter,  1^  ounces;   rice,  43^ 

ounces;  protein,  98  grams.     Calories,  2,295. 

(2)  Saltless  bread,  7  ounces;   meat,  14  ounces;   butter,  3  oimces;   sugar,  3}/2 

ounces;  protein,  117  grams.     Calories,  3,037. 

(3)  Saltless  bread,  7  ounces;   potatoes,  lOJ/^  ounces;  rice,  3M  ounces;  sugar, 

3}/2  ounces;  butter,  1  ounce;  protein,  33  grams.     Calories,  1,891. 

(4)  Milk,  2  pints;    two  eggs;    meat,  10  ounces;    flour,  2  ounces;    sugar,  1^ 

ounces;  butter,  1^  ounces;  protein,  125  grams.    Calories,  2,292. 

From  the  above  table  it  will  be  seen  that  the  dietary  can  be  varied  so 
that  the  consumption  of  protein  will  vary  but  little  from  the  standard 
advocated  in  these  pages.  The  following  dietary  will  possibly  be  accept- 
able by  most  Americans : 

Breakfast: 

Oatmeal  porridge;  saltless  bread  and  butter;  one  or  two  eggs  (poached  or  but- 
tered); raw  egg-and-milk;  fresh-water  fish,  eaten  with  lemon  juice  or  vinegar. 
Jam,  marmalade,  tomatoes,  or  other  fresh  fruit;  tea  or  cereal;  coffee  made 
with  water  or  milk. 

Midday  Meal: 

Vegetable  soup;  saltless  bread;  cow-heel,  tripe,  unsalted  tongue,  fresh  meat  or 
fowl.  Fish  may  be  taken  once  or  twice  a  week,  with  mayonnaise  sauce,  white 
sauce,  or  bread  sauce.  Milk  puddings;  cream;  custard,  junket;  blanc  mange; 
jelly,  stewed  fruit,  salt-free  biscuits,  or  crackers.  Salt-free  cheese.  Green 
vegetables,  kidney  or  snap  beans,  vegetable  marrow,  spinach,  scorzonera, 
celery,  cauliflower,  and  potatoes,  all  cooked  without  salt,  or  the  minimum 
required  to  give  flavor. 

5  p.m.: 

Tea;  with  salt-free  bread  and  butter;  cakes,  honey,  marmalade,  and  other  con- 
fections. 

Evening  Meal: 

Any  article  from  list  for  the  midday  meal  or  breakfast. 

Bunge(15)  records  extended  and  interesting  observations  and  discus- 
sion upon  the  relation  of  diet  to  the  craving  for  salt,  and  concludes  that 
it  is  possible  for  one  to  live  on  a  diet  largely  vegetarian,  without  the  addi- 
tion of  salt,  yet  on  such  a  diet  one  should  have  a  strong  disinclination  to 
partake  freely  of  vegetables  rich  in  potassium,  such  as  potatoes. 

The  use  of  salt  enables  us  to  employ  a  greater  variety  of  the  earth's  products 
as  food  than  we  could  do  without  it. 

But  according  to  Bunge : 

We  are  accustomed  to  take  far  too  much  salt  with  our  viands.  Salt  is  not  only 
an  aliment;  it  is  also  a  condiment  and  easily  lends  itself,  as  such  things  do,  to 
abuse. 


348     scie:ntific  feeding  of  niteogen  foods 

Sodium  and  chlorin  equilibrium  can  apparently  be*  maintained  on 
less  than  one-fourth  the  amount  of  salt  ordinarily  consumed.  Sodium 
chlorid  partaken  of  with  the  diet  passes  out  of  the  body  through  the 
kidneys  without  undergoing  any  chemical  changes;  the  rate  of  excretion 
adapts  itself  to  the  rate  of  intake  within  wide  variations. 

According  to  Goodall  and  Joslin(16),  when  no  salt  is  taken,  the  rate 
of  excretion  falls  rapidly  to  a  point  where  the  daily  loss  is  extremely 
slight.  In  one  of  their  experiments  upon  a  salt-free  diet,  the  chlorin 
excretion  upon  successive  days  was  as  follows: 

1st  day 4.60  grams  chlorin           7th  day 0.46  grams  chlorin 

2nd  day 2.52      "            "                8th  day 0.40  " 

3rd  day 1.88     «            «                9th  day 0.26  « 

4th  day 0.87      "             «  10th  day 0.22  "            « 

5th  day 0.69      «            «  11th  day 0.22  «            « 

6th  day 0.48     "            «  12th  day 0.17  "            « 

13th  day 0.17  grams  chlorin 

Fotassinm  Chlorid. — Potassium  chlorid  is  next  in  importance  to  sodium 
chlorid.  It  is  a  predominant  salt  in  the  muscular  tissues,  and,  like  sodium 
chlorid,  is  a  common  ingredient  of  nearly  all  the  tissues  and  fluids  of  the 
body.  The  acid  and  neutral  carbonates  and  phosphates  of  sodium  and 
potassium  exert  their  greatest  importance  in  regulating  the  reaction  of 
the  digestive  secretion  and  of  the  urine.  Sodium  is  required  in  the  body 
for  the  proper  constitution  of  its  fluids,  potassium  for  the  construction  of 
cells  and  especially,  perhaps,  of  the  red  blood  cells  and  the  muscles. 

Clinical  experimentation  has  emphasized  the  fact  that  young  animals 
and  children  deprived  of  potassium  salts  in  the  foods  do  not  develop  good 
muscles.  Foods  derived  from  the  vegetable  kingdom  furnish  the  richest 
supply  of  potassium-bearing  salts,  by  three  or  four  times,  while  foods  from 
the  animal  kingdom  contain  a  larger  percentage  of  the  sodium  salts.  If 
potassium  chlorid  is  substituted  for  sodium  chlorid  in  the  food,  various 
disturbances  arise,  owing  to  the  deficiency  of  the  sodium  salt.  The  tissues 
of  the  body  retain  common  salt  most  tenaciously,  and  when  food  is  ingested 
which  is  low  in  this  element,  it  gradually  disappears  from  the  urine. 
When  the  supply  of  common  salt  is  below  the  body  requirement,  the 
elimination  of  chlorid  in  the  urine  decreases.  When  there  is  a  lack  of 
sodium  chlorid  as  compared  with  potassium  chlorid  in  the  food,  potassium 
combinations  replace  sodium  combinations  in  the  body  and  new  combina- 
tions of  sodium  and  potassium  are  formed  and  excreted  in  the  urine. 
Human  beings  who  consume  a  large  amount  of  potatoes  or  other  vegetables 
rich  in  potassium  salts  should  of  necessity  partake  freely  of  common  salt, 
not  merely  as  a  condiment,  but  as  an  essential  part  of  the  food. 


MINEllAL    METABOLISM  349 

Low  Calcium  and  High  Calcium  Diets. — We  learned,  when  studying 
mineral  salts  in  the  body  and  in  foods  (Volume  I,  Chapter  XI),  that 
the  calcium  salts  are  of  value  chiefly  from  their  importance  in  the  com- 
position of  the  bones  and  teeth,  as  well  as  in  many  of  the  tissues  of  the 
body,  more  particularly  with  cell  growth  and  development.  The  bones 
and  tissues  of  young  growing  animals,  and  children  as  well,  require  and 
contain  a  larger  percentage  of  earthy  salts  than  older  ones. 

Calcium  is  taken  into  the  body  in  organic  forms  through  the  ingestion 
of  milk,  yolk  of  egg,  and  cereals,  and  in  inorganic  forms  chiefly  in  drink- 
ing water,  such  as  the  carbonates,  sulphates  and  phosphates.  Both  forms 
are  more  or  less  readily  absorbable,  depending  in  a  measure  upon  what 
salts  are  taken  with  it.  The  minimum  amount  of  lime  by  which  calcium 
equilibrium  may  be  maintained  ranges  from  1  to  II/2  grams  per  day  for 
the  average  sized  adult.  There  seems  to  be  great  variation  in  the  quanti- 
ties by  which  a  calcium  diet  may  be  established ;  5  to  10  per  cent  of  that 
ingested  is  excreted  in  the  urine,  while  the  remainder  is  found  in  the  feces, 
whether  unabsorbed  or  absorbed  and  then  eliminated  in  the  intestine. 
The  amount  of  lime  eliminated  through  the  kidney  varies  greatly — prob- 
ably does  not  average  much  over  one-tenth  of  that  taken  in  the  food.  The 
fact  that  the  greater  part  of  the  calcium  ingested  in  food  reappears  in  the 
feces  has  often  been  interpreted  as  meaning  that  the  requirement  of  the 
body  for  calcium  is  low,  and  the  absorption  of  calcium  from  the  food  is 
poor.  It  must  not  be  lost  sight  of,  however,  that  the  calcium  found  in  the 
feces  comes  from  the  various  organs  and  tissues  of  the  body  as  well  as  from 
the  food.  The  elimination  of  calcium  from  the  food  through  the  intes- 
tinal wall  has  been  proved.  The  elimination  of  lime  salts  through  the 
intestinal  wall  continues  in  fasting,  and  constitutes  the  principal  way  in 
which  lime  is  lost  from  the  body  whenever  the  food  supplies  contain 
insufficient  lime  for  equilibrium.  The  calcium  excretion  in  the  urine 
may  be  increased  by  the  ingestion  of  large  quantities  of  water,  and  by 
the  administration  of  dilute  hydrochloric  acid ;  and  again,  it  may  be  in- 
creased by  the  administration  of  lactic  acid  and  sodium  lactate.  There  is 
a  loss  of  lime  over  that  taken  into  the  body  in  such  diseased  conditions  as 
osteomalacia,  pernicious  anemia,  advanced  tuberculosis  and  in  diabetes. 
This  is  to  some  extent  associated  with  phosphate  elimination.  On  the 
other  hand,  in  arteriosclerosis,  the  excretion  of  lime  is  deficient.  If,  on  a 
given  diet,  the  calcium  is  low,  the  loss  will  greatly  exceed  the  intake.  If, 
on  the  other  hand,  the  diet  contains  excessive  amounts  of  calcium,  some 
of  the  lime  will  be  retained  in  the  body  and  apparently  stored  up  in  the 
bones,  though  it  may  not  produce  symptoms. 


350      SCIENTIFIC    FEEDING    OF    NITROGEN    FOODS 

Voit  experimented  on  a  pigeon  for  a  period  of  twelve  months,  giving 
it  a  diet  poor  in  calcium,  without  observing  any  deleterious  effects  attrib- 
utable to  the  diet.  But  when  the  bird  was  killed  and  dissected,  there  was 
found  marked  wasting  of  lime  salts  from  the  bones  of  the  skull  and 
sternum,  which  were  so  soft  as  to  be  perforated  with  ease.  However,  the 
long  bones,  those  concerned  in  locomotion,  were  still  sound.  The  injuri- 
ous effect  of  foods  containing  insufficient  lime  is  more  noticeable  in  grow- 
ing than  in  full  grown  animals.  Abnormal  weakness,  flexibility  of  the 
bones  will  be  noticed  (like  rickets  in  children).  Puppies  fed  with  lean 
and  fat  meat  only  develop  rickets,  while  control  puppies  from  the  same 
litter  receiving  the  same  food  with  an  additional  allowance  of  bones  to 
gnaw  upon  develop  normally. 

From  the  above,  it  is  apparent  that  the  growing  skeleton  needs  an 
abundance  of  calcium.  Before  birth  the  lime  requirement  of  the  child  is 
satisfied  through  the  maternal  blood,  and  for  many  months  afterward, 
through  the  mother's  milk,  which  is  relatively  rich  in  calcium.  The 
weakening  of  the  bones  and  the  disintegration  of  the  teeth  during  preg- 
nancy and  lactation  is  largely  due  to  the  amount  of  calcium  going  to 
the  child  in  utero  and  during  lactation  in  the  secretion  of  milk.  After 
weaning  and  throughout  early  childhood,  there  are  apt  to  be  frequent  dis- 
turbances of  the  absorption  and  metabolism  of  lime,  due,  in  some  in- 
stances, to  disorders  of  digestion,  in  other  cases,  to  deficiency  of  lime  in 
the  nutrients  ingested  by  the  child.  To  prevent  this  fluctuation,  so  as 
not  to  interfere  with  the  steady  growth  of  the  child,  it  is  imperative  that 
the  food  furnish  a  liberal  supply  of  calcium.  Under  the  most  favorable 
conditions,  a  rapidly  growing  child  will  need  and  consume  more  bone- 
making  material  in  proportion  to  its  total  food  than  is  required  by  men 
who  serve  as  subjects  for  metabolism  experiments.  For  this  reason,  among 
others,  lime  water  is  added  to  the  various  artificial  foods  given  during 
infancy  and  early  childhood.  Unless  a  very  "hard"  water  is  used  for 
drinking  purposes,  it  is  unlikely  that  the  lime  from  this  source  will  sup- 
ply more  than  a  very  small  part  of  the  calcium  required,  so  that  there 
should  be  great  attention  given  to  the  choice  of  such  foods  as  will  increase 
the  calcium  content  of  the  dietary. 

The  table  on  page  351  gives  the  calcium  content  of  a  number  of  staple 
articles  of  food. 

A  study  of  the  table  on  page  353  will  show  that  there  are  enormous  dif- 
ferences in  the  calcium  percentage  of  different  food  products,  milk  being  so 
rich  in  calcium  that  the  quantity  necessary  to  produce  400  calories  contains 
1  gram  of  lime.    In  order  to  get  the  same  amount  of  lime  from  round  steak 


MINERAL    METABOLISM 


351 


and  wliite  bread,   it  would   be  necessary  to  consinne  enou«i;h  to  furnish 
10,000  calories. 

A  low  calcium  diet  is  recommended  in  many  cases  of  arteriosclerosis, 
exerting,  as  is  claimed,  a  beneficial  effect  by  checking  alimentary  toxemia, 
reducing  blood  pressure  and  increasing  diuresis.  The  idea  is,  that  to  keep 
blood  pressure  low,  lime  salts  should  be  eliminated  from  the  diet  as  far  as 
possible.  In  conditions  of  cardiac  failure,  lime  salts  are  allowed,  but 
when  compensation  is  reestablished,  their  use  should  be  discontinued.  It 
should  be  pointed  out,  however,  that  it  has  not  been  proved  that  blood  and 
tissues  retain  calcium  during  the  course  of  arteriosclerosis.  If  at  any 
time  it  is  desirable  to  give  a  calcium-poor  diet,  it  can  be  arranged  from  the 


following  table : 


CALCIUM  IN  FOODS' 


Basal  Foods:  Per  cent 

Meat 002 

Eggs 100 

Cream 147 

Milk 172 

Cheese 1.240 

Bread 021 

Flour:  Fine 028 

Entire  wheat 037 

Cornmeal 009 

Rice 012 

Pearl  barley 0.25 

Macaroni,  vermicelli 028 

Oatmeal 078 

Vecetables: 

Asparagus 038 

Beans:  Dried 215 

Fresh,  string 073 

Beetroot 019 

Cabbage 058 

Carrots 077 

Celery 094 

Cucumber 028 

Greens,  turnip  tops 508 

Lettuce '. 425 

Onions 040 

Parsnips 076 

Peas,  dried 137 

Potatoes 0.16 

Sweet 025 


Vegetables  (Continued):  Per  cent 

Pumpkins 032 

Radishes 025 

Rhubarb 060 

Ruta  baga  (swedes) 103 

Spinach 064 

Tomato 019 

Turnips 0.87 

Vegetable  marrow 0.32 

Watercress 259 

Fruits: 

Apples 01 1 

Apricots. 021 

Bananas 009 

Blackberries 099 

Bilberries 045 

Cherries 026 

Cranberries 021 

Currants 046 

Dried 169 

Grapes 014 

Grapefruit. 029 

Huckleberries 037 

Oranges 043 

Peaches 0.15 

Pears 018 

Pineapple 008 

Plums 022 

Raspberries 072 

Strawberries 057 

Water-melons 018 


Magnesium  Salts. — Magnesium  is  usually  present  in  foods  in  much  the 
same  proportion  as  calcium.     There  are  exceptions,  however,  to  this  rule, 


1  IJiilI.  of  Exper,  Sta.  No.  45,  U.  S.  Dept.  of  Agric. 


352      SCIENTIFIC   FEEDING   OF   NITROGEN    FOODS 

for  in  milk,  magnesium  is  less  and  in  meat  considerably  more  abundant 
than  calcium,  while  in  bread  there  is  actually  five  times  as  much  mag- 
nesium as  calcium.  Magnesium,  however,  is  of  much  less  importance  to 
the  body  than  calcium.  Very  little  magnesium  is  absorbed  from  the  food, 
and  one-third  of  the  intake  is  excreted  in  the  urine  and  about  two-thirds 
in  the  feces. 

The  bones  contain  99%  per  cent  of  the  entire  calcium  content  of  the 
organism,  but  only  71  per  cent  of  the  magnesium.  On  the  other  hand, 
the  muscles  contain  more  magnesium  than  calcium,  but  again  there  is  in 
the  blood  more  calcium  than  magnesium.  The  solubility  of  magnesium 
salts  in  the  body  fluids  is  greater  than  that  of  lime.  Absorption  of  mag- 
nesium both  in  organic  and  inorganic  combinations  takes  place  from  the 
intestinal  canal.  Experiments  in  which  animals  are  given  food  with 
scanty  lime  content,  but  rich  in  magnesium,  have  demonstrated  that  while 
the  bony  structure  resulting  from  such  diet  contains  twice  the  normal 
amount  of  magnesium,  the  development  of  the  osseous  system  is  stunted. 
These  data  offer  practical  proof  that  lime  cannot  be  replaced  by  mag- 
nesium. Since  the  magnesium  salts  are  more  soluble  than  the  lime  salts, 
they  are  eliminated  in  greater  proportion  than  the  latter  by  the  kidneys. 
As  a  matter  of  fact,  most  of  the  absorbed  magnesium  is  excreted  in  the 
urine,  while  the  unabsorbed  magnesium  salts  in  the  form  of  insoluble 
soaps  are  eliminated  in  the  feces.  The  table  on  the  opposite  page  shows 
comparative  amounts  of  the  lime  and  magnesium  salts. 

Phosphorus — Phosphorus  is  essential  for  all  cell  life  and  its  impor- 
tance as  a  building  material  in  the  body  can  scarcely  be  overrated.  Wher- 
ever growth  is  most  active,  there  also  most  phosphorus  is  found.  It  is  a 
component  part  of  all  cell  nuclei  and  is  found  abundantly  in  the  bones 
and  in  the  central  nervous  system.  Wherever  the  building  up  of  such  a 
tissue  is  going  on  rapidly,  a  large  supply  of  phosphorus  in  thq  food  is 
required.  It  is  not  surprising,  therefore,  to  find  that  the  development  of 
young  animals  which  are  deprived  of  phosphorus  is  apt  to  be  seriously 
impaired.  The  importance  of  a  sufficient  amount  and  a  proper  form  of 
phosphorus  in  the  food  of  growing  children  is  to  be  emphasized;  and  it  is 
essential  for  the  growth  of  new  tissues  that  phosphorus  should  be  stored 
in  the  body  as  well  as  nitrogen.  Whenever  there  is  a  storage  of  nitrogen 
a  corresponding  storage  of  phosphorus  is  also  found.  The  importance  of 
phosphorus  as  a  building  material  was  shown  by  Bunge  when  he  dis- 
covered that  the  proportion  of  phosphorus,  calcium  and  protein  in  the 
milk  of  animals  is  directly  proportionate  to  their  growth.  The  table  given 
on  page  354  very  graphically  emphasizes  Bunge's  discovery. 


MINERAL    METABOLISM 


353 


APPROXIMATE  AMOUNTS  OF  MAGNESIUM  AND  CALCIUM  OXID  IN 

FOOD  MATERIALS  1 


Vegetable  Foods 

Ash 

in  per  cent 

of  substances 

Magnesium 
in  per  cent 
of  the  ash 

Calciimi 
in  per  cent 
of  the  ash 

Millet 

5.1 

4.9 

0.67 

2.3 

'2.5 

0.27 

3.4 

2.6 

1.97 

2.3 

3.1 

5.0 

2.25 

0.4 

0.31 

6.4 

0.2 

2.03 

8.8 
11.6 
8.9 
6.4 
4.8 
0.4 
2.1 
3.1 
0.7 

0.4' 
5.4 

25.8 

15.9 

14.9 

13.4 

13.0 

10.9 

10.3 

9.6 

8.7 

8.6 

8.1 

7.9 

7.0 

6.8 

2.5 

8.8 

5.5 

4.7 

6.3 

3.3 

8.8 

5.3 

2.9 

Trace 

3.7 

3.2 

3.5 

3.0 

5.8 

1.9 

6.5 

6.3 

4.8 

9.5 

8.3 

5.2 

Trace 

2.3 

Cocoa 

2.8 

Cornmeal 

6.3 

Rice 

0.8 

Nut  kernels.. 

8.6 

Wheat  flour 

2.2 

Buckwheat 

6.6 

Barley 

3.5 

Apples 

4.0 

Coffee  extract 

3.6 

Peas 

5.1 

Rye  flour 

1.02 

Oatmeal 

3.0 

Tea  extract 

1.2 

Potatoes 

0.8 

Grapes 

36.9 

Cherries 

7.5 

Plums 

4.9 

Asparagus 

15.9 

Lemon  juice 

7.9 

Bananas 

12.5 

Spinach 

13.1 

Savoy 

27.9 

Cauliflower 

21.7 

White  cabbage 

12.6 

Kohlrabi 

10.2 

Radish 

8.8 

Cucumbers 

6.9 

Gooseberries 

12.2 

Lentils 

5.1 

Beans 

8.6 

Schoten 

7.8 

Clover 

36.1 

Poppy  seeds 

35.1 

Sorrel 

31.6 

Pears 

7.9 

Strawberries 

14.2 

Carrots 

5.6 

1  From  von  Liebig  and  other  sources. 


Animal  Foods 

Beef 



15.2 

13.0 

5.0 

6.0 

20.0 

2.9 

Albumin  of  hens'  eggs 

13.0 

Woman's  milk 

24.3 

Yolk  of  egg 

38.0 

Cow's  milk 

151.0 

354       SCIENTIFIC    FEEDING    OF    NITROGEN    FOODS 
IMPORTANCE  OF  PHOSPHORUS  AS  A  BUILDING  MATERIAL  (Bunge) 


Time  required 
to  double  the 
weight  of  a 
new     born 
animal  (Days) 

Milk  of  Mother  Contains 

Protein 
per  cent 

Ash 
per  cent 

Lime 
per  1,000 

P2O5 
per  1,000 

Man 

180 
60 
47 
17 
10 
8 

1.6 
2.0 
3.5 
4.3 
6.5 
7.1 

.2 
.4 

.7 

.8 

.9 

1.3 

.328 
1.240 
1.600 
2.100 
2.720 
4.530 

.473 

Horse 

1.310 

Cow 

1.970 

Goat 

3.220 

Sheep 

4.120 

Dog 

4.930 

Ilohmann(l7),  in  studying  this  subject,  asks  the  question:  "What  in- 
fluence have  the  inorganic  phosphates  on  the  construction  of  phosphorized 
proteins  in  the  body  ?"  In  an  experiment  to  answer  this  question,  says 
Tibbies,  he  fed  animals  on  a  diet  containing  earthy  phosphates  and  diets 
consisting  of  (a)  phosphorized  proteins  (casein  and  vitellin),  (h)  non- 
phosphorized  protein  (edestin).  In  animals  which  subsisted  on  the 
former  diet,  there  was  a  retention  of  nitrogen  and  phosphorus  in  the  body, 
while  in  animals  fed  on  the  latter  no  retention  occurred.  His  conclu- 
sion from  these  observations  is  that  the  body  does  not  appear  to  have  the 
power  of  building  up  the  phosphorized  proteins  of  the  cells  from  the 
non-phosphorized  proteins  and  inorganic  phosphates.  On  the  other 
hand,  he  concluded  that  the  phosphorized  proteins  are  built  up  from 
lecithin  and  non-phosphorized  protein.  From  his  observations,  we  must 
look  to  the  phosphorized  organic  constituents  of  the  food  for  our  supply 
of  phosphorus,  viz.,  nucleoproteins,  phosphoproteins,  nuclein,  lecithin, 
phosphocarnic  acid  and  glycerophosphoric  acid  found  in  the  cellular  ele- 
ments, particularly  in  the  yolk  of  eggs,  sweetbread,  fish  roe,  the  germ  of 
cereals  and  legumes,  and  in  casein.  (For  the  amount  of  phosphorus  con- 
tained in  foods,  see  Volume  I,  Chapter  XI,  pages  271-272.) 

Bunge(18)  has  demonstrated  the  content  of  phosphorus  pentoxid 
(P2O5)  in  100  grams  of  dried  food  to  be:  egg  yolk,  1.90 ;  cow's  milk,  1.86  ; 
beef,  1.83  ;  peas,  0.99  ;  wheat,  0.94 ;  potato,  0.64 ;  egg  albumin,  0.20  grams. 
In  his  work  along  this  line,  Voit  gives  the  following  estimate  of  the 
amount  of  phosphorus  in  the  various  structures  of  a  human  body  weigh- 
ing 154  pounds:  1,400  grams  in  the  bones;  130  grams  in  the  muscles, 
and  120  grams  in  the  nervous  system.  The  determination  of  the  exact 
phosphorus  requirenient  of  the  human  organism  is  not  an  easy  problem. 
Available  data  on  this  subject  are  even  fewer  than  those  dealing  with 


MINERAL    METABOLISM  355 

nitrogen.  Sherman  and  Sinclair  (19)  have  pointed  out  that  the  daily 
amount  of  phosphorus  received  hy  the  body  varies  from  0.9  to  1.5  grams, 
this  variation  depending  upon  the  amount  of  phosphorus  in  the  food  in- 
gested. Interesting  and  instructive  as  this  work  is,  it  is  not  exhaustive. 
But  from  these  studies  it  may  be  inferred  that  a  normal  individual  by 
training  himself  to  exist  on  a  low  protein  diet,  or  on  a  diet  whose  phos- 
phorus content  exists  almost  exclusively  in  organic  combination,  may 
maintain  phosphorus  equilibrium  on  food  containing  about  0.9  grams  of 
phosphorus  or  2  grams  of  phosphorus  pentoxid.  But  to  maintain  a  nor- 
mal phosphorus  equilibrium  on  an  average  unrestricted  diet,  it  would 
seem  that  a  daily  intake  of  about  1.5  grams  of  phosphorus  or  3.5  grams 
of  phosphorus  pentoxid  is  required. 

Iron  Salts. — Iron  is  one  of  the  mineral  constituents  of  the  diet  which  is 
always  present  in  an  organic  form.  It  is  largely  excreted  in  the  feces, 
which  fact  has  led  to  great  difficulty  in  attempting  to  estimate  the  usual 
amount  of  iron  required.  Roughly  speaking,  there  are  about  10  milli- 
grams of  the  metal  contained  in  an  ordinary  mixed  diet  (15).  This  quan- 
tity may  therefore  be  taken  as  sufficient  to  meet  all  physiological  demands. 
It  is  difficult  to  estimate  correctly  the  amount  of  iron  contained  in  the 
different  articles  of  food.  In  foods  derived  from  the  animal  kingdom 
much  depends  on  whether  the  animal  was  bled  when  slaughtered  or  not, 
while,  with  foods  derived  from  the  vegetable  kingdom,  it  varies  very 
greatly,  depending  largely  upon  the  amount  of  iron  in  the  soil  in  which 
the  foods  were  grown.  For  the  estimated  amount  of  iron  contained  in 
different  vegetable  and  animal  foods,  the  reader  is  referred  to  Volume  I, 
Chapter  XI,  page  269.  Physiological  chemists  estimate  that  the  blood (4) 
of  an  adult  contains  3  grams  of  iron ;  the  liver,  spleen,  skin  and  hair  con- 
tain smaller  amounts.  According  to  Nasse,  the  conglomerate  masses  in 
the  spleen  pulp  of  old  horses  contain  about  5  per  cent  of  iron,  while 
Oidlmann  estimated  that  the  ash  of  the  spleen  contains  from  7  to  16  per 
cent  of  iron.  The  iron  content  of  the  blood  in  the  form  of  hemoglobin 
amounts  to  about  0.04  per  cent.  The  iron  of  the  liver  is  stored  in  the 
cells  as  compounds  of  iron  in  nuclein  and  protein.  Physiologists  desig- 
nate two  of  these  compounds  as  Jiepatin  and  ferratin,  and  the  iron  is 
either  the  ferric  or  ferrous  oxid.  The  iron  in  the  liver  of  a  new-born 
animal  is  greater  than  that  in  the  adult  of  the  same  species.  Bunge 
teaches  that  the  liver  acts  as  a  storage  house  for  iron,  which  is  subse- 
quently used  to  form  the  hemoglobin  of  the  red  blood  corpuscles.  Dele- 
piene  coincides  with  this  view.  He  even  considers  the  liver  as  not  only 
the  storehouse  of  the  nucleoprotein  compounds  containing  iron,  but  that 


356       SCIENTIFIC   FEEDING    OF    NITEOGEN    FOODS 

the  liver  cells  are  capable  of  elaborating  these  compounds  into  new  hemo- 
globin for  the  young  red  blood  corpuscles,  which  he  describes  as  the 
ferrogenic  function  of  the  liver  and  which  he  believes  persists  throughout 
life.  The  bile  pigment  is  derived  from  hemoglobin,  but  is  free  from  iron. 
Tibbies  thinks  this  pigment  is  split  off  from  the  hemoglobin,  while  the 
iron-bearing  nucleoproteins  are  stored  in  the  cells  of  the  liver. 

Considerable  variations  in  professional  opinion  have  arisen  as  to 
whether  inorganic  iron  given  as  a  drug  for  the  cure  of  anemia  and 
chlorosis  is  absorbed.  Von  Noorden  and  others  believe  that  inorganic 
iron  is  absorbed  and  they  hold  that  it  is  very  efficient  in  the  treatment 
of  these  maladies.  Hamburger  and  Morden,  on  the  other  hand,  believe 
that  little  or  none  of  the  inorganic  preparations  of  iron  is  absorbed  from 
the  alimentary  canal.  Bunge  believes  that  iron  is  of  therapeutic  value  in 
the  treatment  of  anemia  and  chlorosis.  As  Tibbies  puts  it :  "Chlorosis  is 
attended  by  considerable  fermentation  in  the  alimentary  tract,  whereby 
much  sulphuretted  hydrogen  is  evolved,  and  this  gas  fixes  and  prevents 
the  absorption  of  organic  compounds  in  the  food  which  are  normally 
made  use  of  in  the  manufacture  of  hemoglobin."  Should  there  be 
an  excess  of  inorganic  iron  present,  a  large  proportion  of  the  sul- 
phuretted hydrogen  evolved  will  combine  with  such  iron  to  form 
sulphid,  and  in  this  manner  protect  the  organic  iron  combinations  from 
destruction  by  the  hydrogen  sulphid  (HoS).  If  a  condition  arises  wherein 
the  blood  is  deficient  in  iron  it  will  scarcely  be  possible  or  practicable  to 
make  good  such  deficiency  by  ordering  inorganic  salts  in  the  food.  There 
are  very  few  foods  which  contain  much  inorganic  iron,  although  Stock- 
man and  von  Noorden  believe  that  the  inorganic  iron  contained  in  the 
food  is  absorbed  and  utilized  in  the  production  of  hemoglobin.  If  for  any 
reason  the  food  is  deficient  in  iron,  it  necessarily  leads  to  a  condition  of 
anemia,  which  conclusion  is  supported  by  various  experimental  observa- 
tions. It  is  known  that  the  blood  of  dogs  fed  with  bread  contains  less  iron 
than  the  blood  of  the  same  animals  when  they  are  fed  upon  meat;  or 
even  children,  when  they  receive  only  the  same  proportion  of  iron  per 
kilogram  of  body  weight  as  is  necessary  for  an  adult.  These  tend  to 
become  anemic. 

Sulphur  Salts. — Sulphur  is  present  in  foodstuffs  almost  entirely  in 
organic  combination,  chiefly  in  proteins.  The  amount  present  varies 
considerably,  as  shown  in  Volume  II,  Chapter  IX,  page  272.  Sulphates 
are  derived  from  sulphur  contained  principally  in  fibrin,  egg  albumin, 
the  casein  of  milk,  and  from  such  vegetables  as  corn,  turnips,  cauliflower 
and  asparagus.     The  knowledge  at  the  present  time  of  the  advantages 


MINERAL   METABOLISM 


357 


or  otherwise  of  an  increase  or  diminution  of  sulphur  in  the  food  is  want- 
ing. Where  food  prepared  with  so-called  alum  baking  powder  is  eaten, 
considerable  sulphate  may  appear  in  the  urine  from  this  source. 

The  inorganic  constituents  of  food  are  of  importance  from  the  point 
of  view,  not  alone  of  the  individual  ingredients,  but  of  their  relations  to 
one  another  as  well.  As  we  have  seen,  even  such  elements  as  sodium  and 
potassium,  or  calcium  and  magnesium,  that  are  closely  related  in  chemical 
properties,  are  not  interchangeable  in  the  animal  economy,  and,  more- 
over, in  some  physiological  functions  are  actually  antagonistic  (20).  On 
the  other  hand,  in  some  instances  certain  elements  do  to  a  degree  replace 
other  elements,  as,  for  example,  the  sparing  influence  of  calcium  on  iron 
metabolism  as  a  result  of  which  an  abundance  of  calcium  renders  less  the 
amount  of  iron  necessary  to  maintain  iron  equilibrium. 

Acid-forming  and  Base-forming  Elements  of  Diet. — Another  important 
relation  is  that  of  the  acid-forming  and  base-forming  elements  of  the 
diet.  It  appears  important  that  the  base-forming  elements  of  the 
food  should  be  sufficiently  abundant,  largely,  if  not  wholly,  to  neutralize 
the  acids  formed  in  catabolism,  since  otherwise  there  is  a  tendency  to  the 
production  of  a  condition  of  acidosis,  with  the  withdrawal  of  fixed  alkalies 
from  the  blood  and  tissues  and  an  increased  fixation  of  ammonium  salts 
whereby  the  ammonium  is  not  transformed  into  urea.  While  it  is  not 
absolutely  demonstrated  that  these  conditions  are  immediately  productive 
of  disease,  it  must  be  regarded  as  physiologically  wrong  for  man  and 
correspondingly  disadvantageous.  Moreover,  it  is  quite  likely  that  in  cer- 
tain pathological  conditions  (see  Gout,  Volume  III,  Chapter  XII)  the 
lack  of  base-forming  elements  is  actually  harmful.  Sherman  gives  tlie 
following  tables : 

FOODS  IN  WHICH  ACID-FORMING  ELEMENTS  PREDOMINATE 


Estimated  excess  acid-forming 
elements  equivalent  to  c.c. 
normal  acid  per  100  calories 


Beef,  free  from  visible  fat 

Eggs 

Round  steak 

Oatmeal 

Wheat  flour 

Wheat,  entire  grain 

Rice 

Bacon 

Corn,  entire  grain  (high  protein) 


10 
9 

6.7 
3.2 
2.7 
2.6 
2.4 
1.0 
0.1 


123 


358       SCIENTIFIC   FEEDING   OF   NITROGEN   FOODS 
FOODS  IN  WHICH  BASE-P^ORMING  ELEMENTS  PREDOMINATE 


Estimated  excess  base-forming 
elements  equivalent  to  c.c. 
normal  alkali  per  100  calories 


Celery 

Cabbage 

Potatoes 

Prunes 

Turnips 

Apples 

Milk 

Beans 

Peas 

Corn,  entire  grain  (low  protein). 


40 
10-13.6 
9-12 
7.9 
6.6-12.5 
5 

3.3 

2.9-  6.8 

1.9 

0.8 


Starch,  sugars,  fats  and  oils  do  not  ordinarily  contain  acid-  or  base- 
forming  elements. 

R6sume. — The  older  view  of  Wright (21),  as  to  the  relation  of  the  diet 
to  scurvy,  is  probably  correct,  so  far  as  concerns  its  following  a  withhold- 
ing of  a  base-yielding  diet,  but,  in  view  of  the  recent  works  on  vitamines, 
it  appears  that  it  is  not  the  mere  absence  of  bases  but  of  vitamines  that  is 
the  causative  factor. 

From  the  foregoing  pages,  the  reader  is  able  to  grasp  the  great  impor- 
tance of  the  functions  of  the  mineral  elements  in  the  processes  of  metab- 
olism. Viewing  their  nature  and  importance,  it  is  at  once  obvious  that 
life  could  not  endure  if  its  complex  mineral  requirements  were  not  auto- 
matically and  constantly  maintained  in  a  proper  adjustment. 

While  highly  developed  processes  of  food  manufacture  and  efficient 
world-wide  transportation  facilities  give  us  the  greatest  opportunities  for 
correct  dietetics,  yet  there  are  important  facts  bearing  on  the  relation  of 
food  materials  and  the  metabolism  of  mineral  nutrients  which  open  the 
way  to  greater  injudiciousness  and  positive  abuse  in  dietetics  than  could 
have  been  possible  in  our  more  primitive  days.  The  net  result  emphasizes 
an  obligation  on  our  part  to  prepare  a  defense  of  knowledge  against  the 
misfortunes  of  plenteous  prosperity.  In  order  to  emphasize  sufficiently 
the  importance  of  mineral  metabolism. in  the  processes  of  nutrition  just 
considered  in  the  preceding  pages,  we  will  outline  briefly  some  of  the 
functions  of  the  mineral  elements  in  animal  metabolism : 

As  bearers  of  electricity  the  mineral  elements  dominate  the  whole 
course  of  metabolism. 

They  conduct  nerve  impulses,  and  play  a  leading  role  in  the  general 
process  of  coll  stimulation. 


MINERAL    METABOLISM  359 

They  goveru  the  contraction  of  the  muscles,  inchiding  those  of  the 
heart. 

They  compose  the  central  agency  for  the  maintenance  of  neutrality 
in  the  blood. 

They  enter  into  the  composition  of  every  living  cell. 

They  compose  supporting  structures. 

They  assist  in  the  coordination  of  the  digestive  processes. 

They  activate  enzymes,  and  through  their  control  of  the  chemical 
reaction  of  the  blood  and  tissues  they  govern  enzyme  action. 

They  unite  with  injurious  products  of  metabolism  and  render  them 
harmless  or  useful. 

As  catalyzers  they  may  alter  the  speed  of  reactions,  and  the  rate  of 
metabolism  generally,  as  measured  by  oxygen  consumption. 

Through  their  effects  on  osmotic  pressure  they  govern  the  movement 
of  licjuids,  and  maintain  the  proper  licjuid  contents  of  the  tissues. 

Through  tlieir  control  of  the  imbibition  of  water  by  the  colloids  they 
govern  absorption  and  secretion. 

Through  their  control  of  the  affinity  of  the  blood  for  gases  they  govern 
respiration. 

Finally,  they  control  the  state  of  solution,  precipitation,  mechanical 
aggregation,  chemical  association  and  ionization  of  the  colloids  which 
compose  living  tissue. 


REFERENCES 

1.  Benedict,  A.  L.    Golden  Rules  of  Dietetics. 

'•2.  Hall^  T.  Walker.    Chemistry  and  Physiology  of  Food  Purins. 

'3.  BiRiAN  and  Schurk.     Pfluger's  Archiv,  1900. 

4.  TiBBLES,  William.     Food  in  Health  and  Disease. 

5.  Dknis,  W.     The  Effect  of  Ingested  Purins  on  the  Uric  Acid  Con- 

tent of  the  Blood,  J,  Biol.  Chem.,  1915,  vol.  xxiii,  p.  147. 
().     Sherman^  Mettler  and  Sinclair.     Exper.  Sta.,  U.  S.  Dept.  of 

Agric,  Bull.  No.  227. 
7.     Tachau.    Biochem.  Ztschr.,  1914,  vol.  Ixvi,  p.  253. 
S.      Starling.     Human  Physiology,  1912,  p.  5. 
9.     Abt.  J.  Am.  Med.  Assn.,  1918,  vol.  Ixi,  p.  1275. 

GifAFE.    Deutsch.  Arch.  f.  klin.  Med.,  vol.  cxiii,  p.  1. 

10.  Starling.     Human  Physiology,  1912,  p.  724. 

11.  Fischer.     Edema  and  Nephritis,  1915. 


360       SCIENTIFIC    FEEDING    OF    NITKOGEN    GOODS 

12.  ScHAEFEK.     Science,  1912,  vol.  xxxvi,  p.  289. 

13.  GuYEK.     Tr.  Amer.  Micros.  Soc,  1911,  vol.  xxx,  p.  145. 

14.  Strauss,  H.     Zschr.  f.  phys.  u.  diiitet.  Therap.,  April,  1908. 

15.  BuNGE.     Physiological  and  Pathological  Chemistry,  chap.  vii. 

16.  GoouALL  and  Joslin.     Tr.  Assn.  Am.  Phys.,  1908,  vol.  xxiii,  pp. 

92,   106. 

17.  Ron  MANN.    Pfluger's  Archiv,  vol.  Ixvii. 

18.  BuNGE.     Loc.  cit.,  p.  84. 

19.  Sherman  and  Sinclair.     Exper.  Sta.,  U.  S.  Dept.  Agric,  Bull. 

No.  227. 

20.  Sherman,  H.  C    Chemistry  of  Food  and  Nutrition. 

21.  Wright.     On  the  Pathology  and  Therapeutics  of  Scurvy,  Army 

Med.  Eeports,  1895. 


CHAPTER   XII 

DIET    m   HEALTH 
WiNFiELD  S.  Hall,  Ph.D.,  M.D. 

The  destiny  of  nations  depends  upon  the  character  of  their  diet. 

Dietotherapy — General  Principles:  Amount  of  Food  Required;  Distribu- 
tion of  Meals ;  Composition  of  Meals ;  Influence  of  Diet  on  Constitu- 
tion and  Health ;  Influence  of  Diet  on  Character ;  Influence  of  Diet  on 
Races;  Occupation  and  Diet;  Climate  and  Diet. 

Diet  Studies:  Students'  Clubs;  Mechanics  and  Laborers;  Standard  and 
Actual  Dietaries  Compared;  Negroes  and  Poor  Mexicans. 

Use  of  Alcohol. 

Diet  in  Tropical  Climates:  General  Considerations;  Fruits  and  Vege- 
tables; Milk;  Meats;  Sweets;  Diet  and  Disease;  Conclusions. 

Alcohol  and  Beverages  in  the  Tropics. 

DIETOTHERAPY— GENERAL   PRINCIPLES 

Dietotherapy  is  the  proper  application  of  suitable  food  elements  to 
secnre  a  well-balanced  alimentation  necessary  for  the  preservation  of 
health  and  the  maintenance  of  bodily  strength  and  energy,  or  for  their 
restoration  during  convalescence  after  having  been  impaired  by  disease. 
It  goes  without  saying  that  the  value  of  foods  in  health  must  be  under- 
stood in  order  properly  to  appreciate  their  relative  dietetic  value  in 
disease. 

When  studying  "The  Chemical  Constituents  of  the  Body  and  of 
Foods"  (Volume  I,  Chapter  II),  we  learned  that  the  human  organism  is 
composed  of  some  twenty  different  universally  distributed  chemical  ele- 
ments, of  which  the  following  are  most  essential :  C,  H,  O,  N,  S,  P,  CI, 
Na,  K,  Fe,  and  Mag,  combined  in  the  most  complex  molecules,  some 
of  which  contain  many  hundreds,  even  thousands,  of  atoms.  We  also 
learned,  when  studying  the  "Characters  of  the  Proximate  Principles  of 

361 


362  DIET    m    HEALTH 

Foods"  (Volume  I,  Chapter  III),  that  the  chemical  composition  of  the 
human  body  is  not  always  an  adequate  guide  to  the  selection  of  the  essen- 
tial food  elements,  though  it  is  an  indisputable  fact  that  food  that  is  to 
nourish  an  infant's  body  and  sustain  it  through  childhood  and  puberty 
must  contain  these  elements.  However,  it  is  quite  impossible  to  feed 
human  beings  upon  chemical  elements — to  be  useful  these  must  be  fur- 
nished in  certain  suitable  combinations.  The  table  in  Volume  I,  Chapter 
II,  graphically  shows  the  composition  of  foods.  Many  of  these  com- 
pounds during  the  process  of  digestion  and  assimilation  (Volume  I, 
Chapter  VII)  are  transformed  into  other  compounds  wdiich  are  peculiar 
to  the  human  body.  Even  when  food  material  has  been  adapted  to  the 
needs  of  the  body  by  digestion,  it  still  undergoes  further  chemical  modi- 
fication before  it  can  be  taken  up  by  the  cells  for  their  repair,  or  stored 
by  them,  or,  by  contact  with  them,  be  transformed  into  heat  or  muscular 
power. 

Thus  we  see  that  the  human  economy  requires  foods  similar  in  com- 
position to  its  own  substance  for  growth,  development  and  repair,  while 
it  needs  fuel  foods  from  which  to  produce  active  energy  for  the  work  of 
the  body.  We  have  already  studied  these  two  phases  of  body  require- 
ments— growth  and  repair  on  one  side,  and  work  on  the  other — and  find 
that  they  make  the  basis  for  the  classification  of  foods,  as  outlined  in 
Volume  I,  Chapter  IX. 

Man  is  an  omnivorous  animal  and  can  subsist  on  either  animal  or 
vegetable  foodstuffs,  and  derive  force  and  bodily  heat  from  any  of  them, 
and,  as  the  body  soon  adapts  itself  to  its  food,  very  few  rules  need  be 
formulated.  People  in  the  upper  walks  of  life,  as  a  rule,  consume  more 
protein  and  ingest  less  carbohydrates  than  do  the  working  classes.  The 
dietaries  of  public  institutions  are  more  liberal  with  allowances  of  carbo- 
hydrate foods  than  with  protein,  on  account  of  economic  advantages,  but, 
as  stated  elsewhere  (Volume  II,  Chapter  IX),  the  protein  from  vege- 
tables, especially  from  beans,  peas  or  lentils,  can  be  secured  at  very  reason- 
able prices  and  ought  to  be  more  universally  used,  especially  when  the 
prices  of  meats  are  prohibitive. 

Amount  of  Food  Required. — The  amount  of  food  necessary  for  a  healthy 
individual  depends  upon  his  age,  the  amount  of  muscular  activity  he  ex- 
pends, the  climate  (or  the  weather),  and  certain  other  factors,  such  as  the 
activity  of  one  or  more  of  the  ductless  glands,  as  well  as  on  certain  indefi' 
nite  and  little  understood  factors  which  we  group  together  as  "inherited." 
All  physicians  called  upon  to  treat  disorders  incident  to  childhood  are  well 
aware  of  the  enormous  appetites  of  normal  children  who  are  active;  but 


JJlETOTllEKArV— GENEKAL    riU^^CirLES  363 

they  sometimes  lose  sight  of  the  fact  that  the  dosags  of  milk,  which  is 
accepted  for  a  six-months'  child,  is  for  the  average  hospiinl  cliild  aud  not 
for  the  normal,  healthy,  active  child,  which  would  grow  faster  on  a  more 
liheral  allowance  of  food.  Students  of  dietetics  understand  that  what  is 
needed  during  hot  weather  is  sufficient  food  with  a  liberal  allowance  of 
water  to  counteract  the  heat  liberated  in  burning  the  food.  The  value  of 
peppers  and  other  condiments  in  the  tropics  is  that,  given  water  enough, 
perspiration  is  stimulated  and  the  more  it  is  stimulated  the  more  rapidly 
the  body  is  cooled. 

The  Relation  of  Height  to  Weight. — This  is  by  no  means  a  fixed 
ratio,  as  considerable  variations  may  exist  without  indication* of  disease; 
on  the  other  hand,  any  great  disparity,  other  things  being  equal,  shows 
that  tlie  balance  of  nutrition  is  disturbed,  and  in  consequence  the  chances 
for  longevity  are  lessened.  Height  is  qualified  by  the  adjectives :  dwarf- 
ish, short,  medium,  tall ;  while  the  patient  is  described,  from  the  weight 
point,  as  emaciated,  thin,  spare,  medium,  stout  or  obese.  Insurance  com- 
panies have  adopted  a  general  ratio  of  height  to  weight  for  different  ages — 
with  a  minimum,  average  and  maximum  weight — which  is  graphically 
illustrated  in  the  table  on  pp.  364-5.  Changes  in  body  weight  varying 
from  the  nonnal,  form,  in  most  instances,  a  reliable  index  to  the  tendency 
of  the  malady ;  progressive  loss  indicates  an  advance  of  the  disease,  while 
progressive  increase  in  weight  suggests  a  lessened  activity  of  the  disease. 
As  a  rule,  individuals  of  moderate  height  and  weight  are  best  adapted  to 
pass  successfully  through  the  ordinary  trials  of  life  and  the  extraordinary 
ordeals  of  disease,  but  the  thin,  "wiry"  person  may  accomplish  an  enor- 
mous amount  of  work  without  excessive  fatigue,  and  emerge  triumphantly 
from  a  severe  attack  of  illness.  On  the  other  hand,  there  are  stout,  hale 
and  hearty  individuals  who  refuse  to  grow  thin,  be  worn  out,  or  to  degen- 
erate, but  who  hang  on  to  life  in  spite  of  serious,  acute  or  debilitating 
disease. 

The  food  requirements  for  adults  living  under  similar  environments 
vary  with  the  weight  of  the  individual.  The  larger  the  body  the  more 
food  will  be  required  {see  Volume  II,  Chapter  IX),  for,  as  has  already 
been  pointed  out,  the  extent  of  the  body  surface  influences  in  a  measure  the 
radiation  of  heat  or  energy,  and  the  larger  the  surface  the  more  food  per 
kilo  will  be  consumed.  This  has  been  tested  experimentally,  both  in  man 
and  animals,  and  the  conclusions  reached  are  that  the  food  must  he  pro- 
portional to  the  weight  of  the  body  and  area  of  body  surface. 

The  dissipation  of  boat  varies  with  the  condition  of  rest  or  work. 
While  at  rest  an  individual  weighing  154  pounds   (70  kilos)   during  a 


364 


DIET    1^   HEALTH 


TABLE  OF  STANDARD  HEIGHT  AND  WEIGHT  AT  VARYING  AGES 

(Based  upon  an  analysis  of  74,163  accepted  male  applicants  for  life  insurance,  as  reported 
to  the  Association  of  Life  Insurance  Medical  Directors,  1897) 

(The  figures  above  and  below  are  20  per  cent  over  and  under  the  average) 


Aees 

15-24 

25-29 

30-34 

35-39 

40-44 

45-49 

50-54 

55-59 

60-64 

65-69 

5  feet  0  inches 

96 
120 
144 

100 
125 
154 

102 
128 
154 

105 
131 
157 

106 
133 
160 

107 
134 
161 

107 
134 
161 

107 
134 
161 

105 
131 
157 

5  «   1   "  

98 
122 
146 

101 
126 
151 

103 
129 
155 

105 
131 
157 

107 
134 
161 

109 
136 
163 

109 
136 
163 

109 
136 
163 

107 
134 
161 

5  «   2   «  

99 
124 
149 

102 
128 
154 

105 
131 
157 

106 
133 
160 

109 
136 
163 

110 
138 
166 

110 
138 
166 

110 
138 
166 

110 
137 
164 

5  "  3   «  

102 
127 
152 

105 
131 
157 

107 
134 
161 

109 
136 
163 

111 
139 
167 

113 
141 
169 

113 
141 
169 

113 
141 
169 

112 
140 
168 

112 
140 
168 

5  «   4   «  

105 
131 
157 

108 
135 
162 

110 
138 
166 

112 
140 
168 

114 
143 
172 

115 
144 
173 

116 
145 
174 

116 
145 
174 

115 
144 
173 

114 
143 
172 

5  "   5   "  

107 
134 
161 

110 
138 
166 

113 
141 
169 

114 
143 
172 

117 
146 
175 

118 
147 
176 

119 
149 
179 

119 
149 
179 

118 
148 
178 

118 
147 
176 

5  "   6   "  

110 
138 
166 

114 
142 
170 

116 
145 
174 

118 
147 
176 

120 
150 
180 

121 
151 
181 

122 
153 
184 

122 
153 
184 

122 
153 
184 

121 
151 
181 

5  "   7   «  

114 
142 
170 

118 
147 
176 

120 
150 
180 

122 
152 
182 

124 
155 
186 

125 
156 

187 

126 
158 
190 

126 
158 
190 

126 
158 
190 

125 
156 
187 

5  "   8   "  

117 
146 
175 

121 
151 
181 

123 
154 
185 

126 
157 
188 

128 
160 
192 

129 
161 
193 

130 
163 
196 

130 
163 
196 

130 
163 
196 

130 
162 
194 

5  "  9   «  

120 
150 
180 

124 
155 
186 

127 
159 
191 

130 
162 
194 

132 
165 
198 

133 
166 
199 

134 
167 
200 

134 
168 
202 

134 
168 
202 

134 
168 
202 

5  «  10   "  

123 
154 
185 

127 
159 
191 

131 
164 
197 

134 
167 
200 

136 
170 
204 

137 
171 
205 

138 
172 
206 

138 
173 
208 

139 
174 
209 

139 
174 
209 

5  «  11   «  

127 
159 
191 

131 

164 
197 

135 

169 
203 

138 
173 

208 

140 
175 
210 

142 
177 
212 

142 
177 
212 

142 
178 
214 

144 
180 
216 

144 
180 
216 

DIETOTHEKArY— GENERAL    PKINCIPLES  365 

TABLE  OF  STANDARD  HEIGHT  AND  WEIGHT  AT  VARYING  AGES— Con. 


Ages 

15-24 

25-29 

30-34 

35-39 

40^4 

45-49 

50-54 

55-59 

60-64 

65-69 

132 

136 

140 

143 

144 

146 

146 

146 

148 

148 

6  "   0  inches 

165 

170 

175 

179 

180 

183 

182 

183 

185 

185 

198 

204 

210 

215 

216 

220 

218 

220 

222 

222 

136 

142 

145 

148 

149 

151 

150 

151 

151 

151 

6  "   1   «  

170 

177 

181 

185 

186 

189 

188 

189 

189 

189 

204 

212 

217 

222 

223 

227 

226 

227 

227 

227 

141 

147 

150 

154 

155 

157 

155 

155 

154 

154 

6  "   2   «  

176 

184 

188 

192 

194 

196 

194 

194 

192 

192 

211 

221 

226 

230 

233 

235 

233 

233 

230 

230 

period  of  twentj-four  hours  gives  off  15  cubic  feet  of  COg.  Since  1  cubic 
foot  of  CO2  produced  by  combustion  involves  an  expenditure  of  heat 
equivalent  to  160  foot  tons  of  energy,  it  follows  that  15  x  100  (2,400) 
foot  tons  are  required  for  the  maintenance  of  normal  temperature  and 
the  ordinary  functions  of  the  organism  while  the  body  is  at  rest.  And 
since  one  calorie  equals  1.54  foot  tons  of  energy,  2,400  foot  tons  are 
equivalent  to  about  1,550  calories,  i.e.,  22.3  calories  for  each  kilo  of  body 
weight.  Playfair  and  Parkes  conducted  studies  to  determine  the  minimum 
food  requirement  and  concluded  that  this  amount  of  heat  and  energy 
would  be  furnished  from  the  combustion  in  the  body  of  dry  albumin,  fat 
and  carbohydrate — barely  yielding  the  "sustenance  diet." 

Later  investigations  show  that  the  amount  of  food  required  to  supply 
the  heat  expended  per  kilo  of  body  weight  by  an  adult  under  various 
conditions,  from  absolute  rest  to  strenuous  activity  or  laborious  work, 
ranges  as  follows : 

TABLE  OF  ADULT  REQUIREMENTS  PER  KILO 

For  sustenance  only 23.0  calories 

During  rest  in  bed 25.0  " 

Sedentary  occupations 35.0  " 

Very  light  work 40.0  « 

Moderate  work 42.0  " 

Laborious  work 60.0  " 

Extra  strenuous  labor 120.0  " 

A  normal  individual  free  from  digestive  disturbances  and  physically 
fit,  who  ingests  a  well-balanced  ration  scientifically  calculated  according 
to  his  age,  height,  weight  and  area  of  body  surface  will,  without  question, 
maintain  the  normal  ratio  of  weight  for  his  age  and  height. 


366  DIET    11^   HEALTH 

When  the  normal  amount  of  food  is  consumed  by  a  healthy  individual, 
other  things  being  equal,  physiological  growth  will  occur,  but  if  food  is 
ingested  in  too  large  quantities,  or  if  the  body  is  inactive,  food  above  the 
actual  requirements  will  be  stored  in  the  form  of  fat.  Lack  of  exercise 
in  such  a  case  will  tend  to  stoutness,  for  the  "contented"  person,  as  a  rule, 
moves  along  the  lines  of  least  resistance ;  his  mind  and  muscles  are  oftener 
at  ease,  and  so  he  burns  less  of  his  food  and  stores  more  than  an  active, 
energetic  person.  "Laugh  and  grow  fat"  is  a  physiologic  truth,  but,  on  the 
other  hand,  many  adipose  persons  are  impetuous,  impatient  and  discon- 
tented, and,  again,  many  are  strenuously  active.  In  such  cases  one  of  two 
things  has  happened  :  either  they  have  inherited  a  type  of  metabolism  which 
is  not  normal  for  the  race,  or  something  is  wrong  with  the  internal  secre- 
tory organs,  especially  the  pituitary,  the  thyroid,  or  the  sex  glands.  The 
thin,  lean,  lanky  individual  is  one  who  eats  too  little  or  exercises  too  much 
for  the  diet  consumed,  is  nervous  from  some  ductless  gland  disorder,  or 
is  just  naturally  "skinny." 

Distribution  of  Meals. — The  early  founders  of  this  country,  like  the  an- 
cient Greeks,  partook  of  three  meals  daily:  two  light  repasts,  breakfast 
in  the  early  morning,  and  supper  at  the  close  of  the  day ;  and  the  principal 
meal,  dinner,  at  mid-day,  usually  followed  by  an  hour  or  two  of  rest.  This 
custom  still  prevails  in  most  agricultural  districts.  In  the  busy  metro- 
politan centers  the  needs  of  modern  activity  have  changed  the  distribu- 
tion of  meals,  and  the  full  mid-day  repast  is  now  replaced  by  a  light  lunch, 
which  allows,  without  the  rest  of  the  old  regime,  intellectual  or  muscular 
work  almost  immediately  following,  but  which  necessitates  a  substantial 
meal  or  dinner  at  six  o'clock  in  the  evening,  several  hours  before  retiring. 
This  arrangement  of  meals,  without  being  absolutely  hygienic,  appears 
fairly  suitable.  According  to  Gautier(l),  the  well-to-do  English  families 
of  what  is  termed  the  middle  class,  and  the  German  families  in  easy  cir- 
cumstances, have  breakfast  at  nine  o'clock,  dinner  at  two  (this  is  the  prin- 
cipal meal),  tea  at  five,  consisting  of  tea,  coffee,  cocoa  or  beer,  with  bread, 
butter  and  cheese  or  ham,  and  lastly  a  light  supper  just  before  retiring. 

Composition  of  Meals. — The  composition  of  the  meals,  as  pointed  out  in 
Volume  TI,  Chapter  VIT,  should  vary  with  the  nature  of  the  occupation. 
A  light  but  sufficient  repast  at  the  noon  hour  suits  those  who  are  occupied 
chiefly  with  office  work  or  business  activities;  but  for  the  workman  or 
peasant  who  from  six  or  seven  o'clock  in  the  morning  to  mid-day  or  one 
o'clock,  has  been  engaged  in  strenuous,  tiring  exercise,  the  noon  repast 
should  bo  sufficiently  liberal  to  allow  him,  not  only  to  make  good  his  losses, 
but  also  to  provide  him  afresh  with  expendable  energy.     According  to 


DIETOTHKRxVPY— GEXP:RAL    PRINCIPLES  367 

Pavlov,  it  is  necessary  to  iioniial  digestion,  that  food  should  be  taken  at 
regular  intervals.  He  cautions  against  the  ingestion  of  too  large  a  meal 
at  one  time,  which  overloads  the  stomach  and  hinders  digestion. 

Kecent  physiological  experiments  emphasize  the  fact  that  meat  remains 
in  the  stomach  several  minutes  (15  to  45)  before  pepsin  is  secreted,  which, 
without  doubt,  is  a  provision  of  Nature  to  allow  the  ptyalin  of  the  saliva 
to  transform  some  of  the  cooked  starches  into  sugar,  as  well  as  to  make 
an  alkaline  coating  to  the  bolus  of  starchy  food.  Later  the  acidity  of  the 
gastric  juice  produced  must  be  sufficient  to  excite,  in  the  duodenum,  the 
pancreatic  and  intestinal  secretions. 

The  inhabitants  of  the  Polar  regions  subsist  almost  entirely  upon 
food  from  the  animal  kingdom,  which  is  rich  in  fat,  the  dwellers  on  the 
borders  of  the  Frozen  Sea — Laplanders  and  Greenlanders — feeding  almost 
entirely  on  fish  and  the  flesh  and  fat  of  seals,  probably  as  much  from  in- 
stinct as  from  the  impossibility  of  securing  other  food.  The  Arab,  on  the 
contrary,  is  satisfied  with  a  few  dates  and  a  little  couscous (2),  the  latter 
a  kind  of  food  used  by  the  natives  of  Northern  Africa,  made  from  flour 
cooked  with  flesh  and  other  ingredients,  as  the  leaves  of  baobab.  The 
Italian  finds  his  macaroni  quite  sufficient,  while  the  inhabitants  of  the 
intermediate  zone  use  a  ration  well  balanced  with  nitrogenous,  fatty  and 
carlMthydrate  foods. 

The  annual  consumption  of  meats  in  different  countries  may  be  of 
interest  to  the  reader.  In  the  United  States  the  annual  consumption  per 
capita  per  annum  is  172  pounds,  or  about  one-half  a  pound  per  day  for 
each  individual,  man,  woman  or  child.  As  many  women  and  children 
consume  very  little,  there  must,  therefore,  be  a  large  number  of  men  who 
ingest  enormous  quantities  of  meat.  Gautier(l)  points  out  that  the  Eng- 
lishman consumes  180  pounds  per  capita ;  the  Frenchman's  annual  con- 
sumption of  meat  is  86  pounds;  while  the  dweller  in  the  City  of  Paris 
consumes  207  pounds ;  the  average  consumption  per  capita  in  the  larger 
towns  in  France  is  158  pounds,  while  the  peasantry  can  scarcely  afford. 
42  pounds  per  annum.  According  to  this  figure,  the  peasantry  are  com- 
pollod  to  subsist  on  about  26  grams  of  fresh  meat  per  moal.  The  Aus- 
tralian is  the  grentost  meat  consumer  of  all,  the  annual  consumption  ])or 
ca])ita  being  in  the  neighborhood  of  240  pounds. 

When  studying  the  subject  of  "Protein  and  Nutrition,"  *  we  found  that 
the  lowest  protein  demand  was  about  65  grams  per  day ;  the  quantity  that 
the  French  peasant  consumes,  therefore,  is  insufficient  for  the  workman 
and  laborer  who  have  most  need  of  it.     Gautier  states  that  "even  at  the 

1  F!c€  Volume  II,  Chapter  VIT. 


368  DIET    IN   HEALTH 

present  time  meat  is  only,  so  to  speak,  a  relish  for  the  countryman.  A 
townsman,  on  the  other  hand,  generally  eats  more  meat  than  agrees  with 
him.  We  have  seen  that  in  Paris  the  alimentary  principles  of  animal 
origin  exceed  480  grams  per  day,  260  grams  of  which  are  meat,  and  this 
figure  must  at  least  be  doubled  for  many  unemployed  townsmen." 

As  the  opinui  smoker  feels  the  need  of  the  drug  when  he  does  not  have 
it,  so  the  individual  who  accustoms  himself  to  partaking  excessively  of 
animal  foods  misses  them  when  he  fails  to  consume  the  usual  excessive 
quantity.  In  contrast  with  the  large  meat  eater  of  easy  circumstances, 
the  peasant  does  not  eat  enough  meat.  His  dietary  is  too  exclusively 
vegetable  and  forces  upon  him  a  regular  digestion  of  dishes  of  great 
volume — potatoes,  green  vegetables,  fruits,  etc. — which  bring  him  only 
an  insufficient  supply  of  nitrogen.  In  this  class  it  is  common  to  find 
gastralgia,  dyspepsia  and  enteritis.  This  unbalanced  diet  is  fortunately 
offset,  to  a  large  extent,  by  strenuous  exercise  in  the  open  air,  ventilated, 
isolated,  sunny  dwellings,  good  rest  at  night,  and  sometimes  in  the  summer 
niontlis  a  siesta  at  noonday,  with  the  minimum  of  inducements  to  intem- 
perance and  vices  which  beset  the  city  dweller ;  but  in  spite  of  the  great 
and  many  advantages  of  living  in  the  open,  the  average  life  of  the  coun- 
tryman, according  to  Gautier(l),  is  shorter  than  that  of  a  man  in  the 
middle  class  in  the  towns.  Gautier's  statement  may  be  correct  for  French 
peasants,  but  the  agricultural  classes  in  this  country  outlive  by  many 
years  the  working  men  of  the  cities. 

Influence  of  Diet  on  Constitntion  and  Health The  influence  of  standard 

dietaries  on  constitution  and  health  has  been  referred  to  already  when 
considering  the  subject  of  "Protein  and  Nutrition."  There  was  outlined 
the  standard  dietary  for  different  occupations,  founded  principally  on  the 
experiments  of  Chittenden  and  other  workers  in  this  field  of  research. 
This  dietary  provides  for  the  physiological  needs  and  losses  of  the  system 
in  quantities  and  kinds  of  foods  best  suited  for  a  healthy  adult  whether 
engaged  in  strenuous  exercise  or  living  a  more  or  less  inactive  life.  On 
the  other  hand,  a  careful  examination  of  the  tables  in  Volume  II, 
Chapter  V,  will  show  the  quantity  of  protein,  fat  and  carbohydrate 
necessary  to  provide  for  the  requirements  of  calorification,  which 
varies  gi-eatly  according  to  the  temperature  of  the  surrounding  atmos- 
phere. Gautier  estimates  that  a  Frenchman,  in  relative  repose, 
needs  from  80  to  82  grams  of  protein  (one-half  of  which  should  be 
furnished  by  animal  food  and  the  other  half  by  vegetable  food). 
He  considers  this  sufficient,  and  if  the  daily  diet  is  increased,  as 
often  happens  in  Paris,  to  102  grams  of  protein,  the  difference  of  20  or 


DIETOTHERAPY— GENERAL    PRINCIPLES  369 

more  grams  constitutes  a  reserve  supply.  The  day  laborer  who  lives  from 
hand  to  mouth,  for  economic  reasons,  receives  only  the  necessary  amount 
of  food  for  daily  v^^ear  and  tear,  and,  as  a  consequence,  is  constantly  in 
danger  of  a  deficiency.  If  he  happens  to  be  called  upon  to  carry  out  a 
strenuous  task,  if  any  of  the  bodily  functions  be  slightly  disturbed,  and  if 
his  sleep  is  not  sufficient  for  repair,  these  causes,  and  many  others  besides, 
by  diminishing  the  receipts  or  increasing  the  expenditures,  will  augment 
the  deficiency,  and  if  there  are  no  storage  reserves  to  meet  this  condition, 
it  will  have  to  be  supplied  by  combustion  of  the  substance  of  the  organs. 
Henceforth,  a  part  of  the  mechanical  work,  or  even  the  maintenance  of 
animal  temperature,  will  be  affected.  If  the  store  of  fats  is  exhausted, 
the  bodily  functions  will  destroy  some  portion  of  the  proteins  of  the  tissues 
in  place  of  the  sugars  or  the  defaulting  fats.  In  order  to  prevent  such 
deficiencies  and  losses — and  not  to  be  driven  to  heat  the  house  by  burning 
the  furniture-^— the  system  must  have  a  reserve  at  its  disposal,  namely  that 
created  by  ingesting  slightly  more  at  each  meal  than  is  required  for  body 
metabolism.  The  old  adage,  that  we  should  "lay  by  something  for  a  rainy 
day,"  is  as  true  in  nutrition  as  in  finance.  It  is  necessary  that  the  gain 
of  to-day  should  suffice  to  compensate  for  the  loss  of  to-morrow,  and  that, 
by  means  of  a  sufficient  surplus  beyond  the  daily  requisite  allowance,  it 
should  be  possible  to  provide  not  alone  for  mobile  equilibrium,  but  to  pre- 
pare the  system  so  that  the  losses  will  never  exceed  the  supply.  This  is 
especially  important  with  reference  to  proteins  and  organic  mineral  salts. 

From  the  above  it  may  be  seen  how  important  it  is  to  eat  slightly  more 
than  the  minimum  requisite  daily  ration.  At  the  same  time  it  must  be 
borne  in  mind  that  this  excess  may  in  turn  bt^come  dangerous  if  carried 
beyond  certain  limits.  The  proteins,  if  not  utilized  by  means  of  mechan- 
ical labor,  by  ]X)werful  work  of  the  lungs  and  skin,  by  a  sufficient  combus- 
tion and  normal  radiation  of  heat,  will,  when  all  their  waste  accumulates  in 
the  organism,  accentuate  a  predisposition  to  obesity,  arthritis,  and  diseases 
of  the  skin,  and  augment  visceral  congestion  and  neuropathic  conditions. 

A  well-balanced  dietary  for  the  working  man  engaged  in  strenuous 
occupations  in  the  open  air  would  be  a  dangerous  ration  for  the  sedentary 
citizen  who  expends  but  little  muscular  energy,  or  for  the  artist  and  stu- 
dent who  devote  themselves  entirely  to  intellectual  occupation (3).  In 
young  people  during  adolescence,  or  in  those  individuals  whose  organs, 
whatever  be  their  age,  have  largely  preserved  their  normal  activity,  a 
slight  indulgence  beyond  the  normal  requirements  of  a  well-balanced 
dietary  will  exert  no  other  effect  than  necessitating  a  greater  activity  of 
the  excretory  organs — lungs,  liver,  skin  and  kidneys.     But  this  will  not 


370  DIET    IN    HEALTH 

apply  to  those  whose  constitution  or  bodily  habits  are  defective  to  begin 
with.  In  such  individuals  a  dietary  in  excess  of  actual  requirements  will 
daily  accentuate  decay ;  hepatic  or  pulmonary  congestion,  arteriosclerosis, 
degenerative  conditions  of  the  kidneys  and  of  various  other  organs  will  in- 
crease, and  there  will  be  eventually  established,  little  by  little,  if  not  dis- 
ease, at  any  rate  a  predisposition  to  it(l).  It  will  readily  be  seen,  there- 
fore, that  the  ingested  aliment  should  be  well  balanced  and  in  proportion 
to  our  needs,  and  regulated  not  by  natural  appetite  alone,  but  by  reason, 
aided,  when  necessary,  by  the  advice  of  those  who  have  devoted  much  time 
and  energy  to  working  out  these  intricate  problems. 

Influence  of  Diet  on  Character.- — The  character  of  individuals  is  un- 
doubtedly more  or  less  influenced  by  diet.  If  a  certain  alimentation 
influences  the  general  health  by  reason  of  its  abundance  or  insufficiency, 
why  may  it  not  act  still  more  by  its  nature  ?  It  is  a  universally  accepted 
fact  that  the  most  robust,  active  and  aggressive  people  are  great  meat 
eaters.  People  whose  chief  subsistence  is  composed  largely  of  carbohy- 
drate foods — vegetables  and  fruits — are  nearly  always  peaceful,  as,  for 
instance,  the  inhabitants  of  Central  Asia,  with  whom  rice  and  vegetables 
with  a  little  pork  or  fish  form  the  principal  articles  of  diet  (4).  We  cannot 
help  coupling  these  facts  with  the  statement  previously  made  that  carniv- 
orous animals  are  generally  fierce  and  savage,  while  the  herbivora,  on  the 
contrary,  are  easy  to  tame  and  domesticate.  Excessive  or  exclusive  flesh 
diet  plays  even  a  greater  role  than  racial  peculiarities  in  influencing  the 
temper  of  an  individual.  Gautier(l)  is  authority  for  the  statement  that 
white  (laboratory)  rats  are  manageable  and  easy  to  tame  as  long  as  they 
are  fed  on  bread  or  grain,  but  when  fed  on  flesh  they  become  snappy  and 
aggressive — given  to  biting.  Liebig  relates  that  a  bear  kept  in  a  museum 
at  Giessen  was  a  gentle,  docile  animal  when  fed  exclusively  on  bread  and 
vegetables,  but  a  few  days  on  animal  diet  caused  it  to  become  fierce  and 
dangerous,  even  to  its  keeper. 

We  may,  then,  safely  adduce  the  theory  that  diet  influences  tempera- 
ment. An  exclusive  animal  diet  makes  one  more  aggressive,  pugnacious, 
determined  and  self-willed ;  while  an  exclusive  vegetable  diet  depletes  and 
enfeebles  the  violence  of  temperaments  and  softens  and  subdues  manners. 
This  fact  has  long  been  understood  by  the  founders  of  religious  orders  in 
Europe,  India  and  Asia,  who  have,  accordingly,  limited  or  prohibited  the 
allowance  of  animal  food  in  the  dietary. 

In  studying  the  "Processes  of  Digestion,"  we  learned  that  vegetable 
food  is  less  completely  assimilated  than  animal  food,  imposing  greater 
exertions  on  the  part  of  the  intestine,  thereby  diverting  part  of  its  energy 


DIETOTHERAPY— GENERAL   PRINCIPLES  371 

to  the  accomplislimeiit  of  these  k)wer  functions;  it  introduces  into  the 
system  far  less  nutrition  than  meats,  and  far  less  of  those  sapid  extractive 
matters  which  stimulate  the  heart,  prod  the  muscle,  and  augment  mechan- 
ical energy (1).  It  is,  therefore,  plain  that  an  exclusively  vegetable  diet 
perceptibly  weakens  and  softens  the  will.  The  wolf  and  wild  cat — speci- 
mens of  the  most  dangerous  carnivorous  animals — have  been  domesticated 
by  a  change  of  diet  into  docile,  peaceable,  friendly  household  pets — dogs 
and  cats. 

Influence  of  Diet  on  Races — If  we  accept  the  theory  that  diet  affects 
the  development  of  the  organs  and  character,  we  can  hardly  deny  that  it 
also  modihes  races.  Darwin  voiced  the  opinion  that  alimentation  which 
creates  internal  conditions  is,  with  the  influence  exercised  by  external  con- 
ditions and  selection,  the  preponderant  cause  of  the  variations  observed  in 
animals.  Gautier  believes  that  the  qualities  peculiar  to  each  individual 
and  each  race  are  perceptibly  influenced  by  the  continuous  action  of  diet, 
and  that,  reciprocally,  when  habits  are  cx)ntracted  and  temperaments 
created  by  long  heredity,  a  special  diet  often  becomes  necessary.  He  says 
an  Englishman  or  Dutchman  will  become  weakened  on  being  deprived  of 
meat  far  more  quickly  than  the  Spaniard,  Southern  Frenchman  or  Italian, 
and  that  the  latter  races,  when  fed  on  the  same  food,  if  almost  entirely 
vegetable,  will  be  able  to  perform  much  more  work  than  a  member  of  the 
Northern  races.  Beyond  doubt  diet  influences  the  physiological  vigor  and 
character  of  races.  As  a  consequence,  it  must  also  have  a  bearing  on 
intellectual  aptitudes. 

Occupation  and  Diet.  — We  know  that  a  man  doing  mechanical  work  re- 
quires a  dietary  abundant  in  ternary  principles — carbohydrates,  hydro- 
carbons and  meat,  especially  the  latter.  Such  a  dietary,  we  have  seen, 
develops  muscular  force,  energy,  vigor  and  even  violence,  while  on  the 
contrary,  it  is  not  very  favorable  to  the  culture  of  the  artistic  or  scientific 
temperament.  According  to  Gautier,  those  who  would  give  themselves  up 
to  speculation  and  thought,  to  the  exercise  of  their  powers  of  observation 
or  generalization,  the  development  or  expression  of  their  artistic  senti- 
ments, the  cultivation  of  the  abstract  sciences,  etc.,  require  bread,  green 
vegetables,  ripe  fruits,  and,  for  nitrogenous  food,  150  to  200  grams  (5  to 
6  ounces)  of  meat,  fish  or  poultry  per  day,  eggs,  milk  and  other  fooda 
easily  digested  (rice,  carrots,  cauliflower,  asparagus,  mushrooms,  a  small 
quantity  of  potatoes,  etc.),  and  finally  a  few  aromatic  condiments,  together 
with  a  little  coffee  or  tea.  Such  a  diet  is  far  more  suitable  than  one  rich 
in  animal  proteins  and  fats,  and  the  more  so  because  those  who  devote 
themselves  to  exercising  the  mind  or  imagination  generally  take  insuf- 


372  DIET    m   HEALTH 

ficient  physical  exercise,  thus  constituting  themselves  candidates  for 
arthritis,  gout,  hepatic,  cerebral  and  renal  congestions.  Such  predisposi- 
tions are  often  increased  by  the  abuse  of  coffee  or  tea,  sometimes  of  alcohol 
or  tobacco,  and  the  desire  for  condiments  which  momentarily  excite  the 
appetite  which  sedentary  work  tends  to  weaken.  For  them  the  dishes  to 
avoid  are  those  which  are  difficult  to  digest  or  which  require  to  be  taken 
in  a  great  quantity,  too  abundant  meats  and  too  starchy  vegetables. 

For  individuals  who  devote  their  energies  to  intellectual  research,  in 
whom  artistic  impressions  predominate,  the  dietary  allowance  should  be 
that  which  corresponds  to  their  vocation  as  well  as  to  the  climate  in  which 
they  live.  Beyond  doubt,  all  brain  work  consumes  energy  corresponding 
to  the  effort  expended.  Moritz  Schiif  has  "demonstrated  that  every  im- 
pression heats  the  brain  and  the  organism  and  causes  as  a  consequence  an 
expenditure  of  energy."  Physiologists  have  pointed  out  the  fact  that  intel- 
lectual fatigue  does  not  increase  the  quantity  of  the  total  urinary  nitrogen 
and  consequently  the  amount  of  protein  broken  up  or  the  combustion  of 
fats (5)  or  even  the  amount  of  phosphorus  excreted  in  a  given  period  of 
time.  When  considering  the  subject  of  "Hygiene  of  Eating,"  we  empha- 
sized the  point  that  intellectual  effort  should  never  .be  undertaken  imme- 
diately after  or  following  a  large  meal,  when  the  organs  of  digestion  are 
most  active  and  require  that  the  blood  should  not  flow  to  the  brain,  but 
to  the  stomach.  During  sleep,  the  destruction  of  the  nitrogenous  principles 
of  our  tissues  does  not  appear  to  vary ;  but  that  of  the  fatty  bodies  becomes 
greatly  enfeebled  without  the  amount  of  oxygen  absorbed  always  diminish- 
ing in  proportion.  There  is  often  an  accumulation  of  oxygen  in  the  system 
during  the  night's  rest,  especially  in  the  case  of  yoimg  children (6). 

Climate  and  Diet.^ — Climate  and  season  beyond  question  have  an  im- 
portant bearing  on  the  necessary  dietary.  In  cold  climates  and  seasons 
more  heat  is  radiated  from  the  body,  and  the  loss  from  breathing  is  much 
greater ;  therefore  a  richer  dietary  for  the  same  amount  of  work  becomes 
necessary,  and,  similarly,  a  poorej*  dietary  will  suffice  in  a  warm  country. 
As  will  be  seen  further  on  in  this  chapter,  when  considering  diet  in  the 
tropics,  it  is  obvious  that  more  heat  is  radiated  by  evaporation  of  the 
water  from  the  lungs  or  in  the  form  of  perspiration  in  hot  climates,  which 
diminishes  the  proportion "  of  energy  otherwise  capable  of  being  trans- 
formed into  muscular  exertion.  It  is  apparent,  therefore,  that  this  loss  by 
cooling  is  slight,  and  the  individual  will  be  able  to  discharge  his  functions 
and  allotted  tasks  equally  well  on  a  smaller  diet.  Gautier  records  an  in- 
stance where  Catalonians  lived  on  a  dietary  which  provided  them  with 
no  more  than  1,900  to  2,000  calories,  yet  they  were  none  the  less  good- 


DIETOTHERAPY— GENERAL    PRINCIPLES 


373 


tempered,  liealthj  and  muscular,  and  capable  of  executing  a  great  amount 
of  work.  This  author  also  quotes  Maurel  of  Toulouse,  who  has  done  some 
interesting  research  work  along  this  line(7).  Below  is  inserted  a  table 
worked  out  by  Prof.  Maurel  for  the  maintenance  allowance  in  hot  seasons 
and  hot  countries,  cold  seasons  and  cold  countries,  and  finally  the  inter- 
mediate climates  for  normal  individuals  from  twenty  to  thirty: 


MAINTENANCE  ALLOWANCE  ACCORDING  TO  CLIMATES 


Number  of 

Calories  per  24  Hours 

Climate  and  Seasons 

Calories  per 

Man 

Man 

Man 

kilogram 

weighing 
()0  kilograms 

weighing 
70  kilograms 

weighing 
SO  kilograms 

Hot  season  of  hot  countries. . 

30 

1800 

2100 

2400 

Cold  season  of  hot  countries 

and  summer  of  temperate 
countries 

35 

3100 

2450 

2800 

Intermediate  season  of  tem- 

perate countries  and  sum- 
mer of  cold  countries 

40 

2400 

2800 

3200 

Cold    season    of    temperate 
countries  and  intermediate 

season  of  cold  countries .  . . 

45 

2700 

3150 

3600 

Cold  season  of  cold  countries 

50 

3000 

3500 

4000 

In  the  beginning  of  this  chapter  we  referred  to  diet  in  cold  climates 
and  to  the  enormous  amount  of  moats  and  fats  consumed  by  the  inhabi- 
tants of  the  Polar  and  Arctic  regions.  Wherever  muscular  exercise  be- 
comes a  necessity,  animal  food  should  form  a  large  part  of  the  dietary, 
and  the  allowance  should  be  relatively  more  liberal  in  proportion  to  the 
degree  of  work  to  be  performed.  Explorers  have  given  us  the  advantage 
of  their  experiences  in  the  Arctic  regions  in  allowing  a  certain  propor- 
tion of  alcoholic  beverages  with  meals (8).  During  a  cold  season  or  in 
the  Arctic  regions  the  question  of  resisting  cold  is  a  vital  one.  We  have 
seen  that  the  ingestion  of  large  quantities  of  fat  and  flesh,  with  this  object 
in  view,  is  of  the  utmost  importance.  The  Eskimo  and  Greenlander  when 
exposed  to  the  cold  will  drink  and  relish  several  pints  of  fish  oil  per  day. 
On  the  other  hand,  in  tropical  climates  and  hot  seasons,  fats,  the  great 
producers  of  heat,  should  naturally  form  only  a  small  part  of  the  daily 
ration,  and  soft  drinks,  lemonades,  etc.,  should  take  their  place.  This 
point  will  be  further  elaborated  on  in  the  section  on  "Foods  in  Tropical 
Countries." 

124 


374 


DIET    IN^    HEALTH 


DIET    STUDIES 

The  dietaries  of  the  inhabitants  of  the  United  States  vary  with  differ- 
ent classes  and  in  different  sections  of  the  country.  Numerous  investiga- 
tions upon  nutrition  have  been  made  in  the  various  parts  of  the  United 
States  under  the  auspices  of  the  Department  of  Agriculture(9).  The 
table  on  page  249  shows  the  dietaries  of  various  classes  of  laborers,  students 
and  professional  men.  This  table  contains  facts  and  figures  with  reference 
to  the  diet  of  students'  clubs  and  colleges  and  contrasts  them  with  the  diet 
of  professional  men  and  mechanics.  It  must  be  borne  in  mind  that  the 
dietaries  contained  in  this  table(lO),  giving  the  protein,  fat,  carbohydrate 
and  energy  content  of  the  various  standard  diets  and  of  the  diet  in  the 
principal  universities  and  for  mechanics  and  other  day  laborers,  does  not 
portray  accurately  the  dietary  of  the  people  of  the  different  sections  of  the 
country.  It  is  evident  from  the  facts  and  figures  in  these  statistics  that 
people  eat  what  their  markets  provide,  except  when  poverty  prevents  pur- 
chasing. For  instance,  the  family  of  a  sewing  woman  in  New  York 
City (11)  averaged  for  one  person  a  day: 

DIETARY  OF  A  POOR  PERSON  IN  NEW  YORK  CITY,  SHOAVING  THE 
FOOD   ELEMENTS   AND   CALORIES 


Protein 

Fat 

Carbo- 
hydrate 

Energy 
Equivalent 

Animal  food 

Grams 
26 
31 

Grams 
34 

7 

Grams 

15 

222 

Calories 

485 

Vegetable  food 

1,100 

Total 

57 

41 

237 

1,585 

Or  a  total  of  57  grams  of  protein  and  1,585  calories,  this  being  less  than 
a  mere  subsistence.  The  articles  of  food  consumed  by  this  family  were 
beef  shank,  pork  chops,  sardines,  eggs,  butter,  milk,  barley,  wheat  flour, 
rye  bread,  wheat  bread,  rolls,  cakes,  crackers,  sugar,  beans,  potatoes,  rad- 
ishes, rhibarb  and  tomatoes.  The  principal  quantities  of  animal  food 
consumed  were  in  the  form  of  eggs  and  milk;  of  carbohydrate,  bread, 
sugar,  potatoes  and  canned  tomatoes. 

Students'  Clubs — The  table  below  outlines  the  various  articles  of  food 
comprising  the  dietary  of  students'  clubs  in  four  different  states,  as  men- 
tioned in  the  table  on  page  249,  Volume  II,  Chapter  IX, 


DIET    STUDIES 


375 


WEIGHT  OF  DIFFERENT  CLASSES  OF  FOOD  PURCHASED  PER  MAN 

PER  DAY(16) 


Tennessee 

Missouri 

Comiecticut 

Maine 

Beef,  veal,  mutton 

Grains 

187 

89 

28 

12 

32 

39 

7 

97 

108 

564 

250 

50 

Grams 

160 

113 

12 

6 

55 

27 

7 

680 

524 

266 

51 

Grams 
245 
91 
6 
24 
35 
60 

457 

361 

189 

89 

Grams 
231 

Pork 

98 

Poultry 

100 

Fish 

77 

EcfiB 

53 

Butter 

52 

Cheese 

Milk 

910 

Buttermilk 

Cereals,  sugar,  etc 

835 

Vegetables 

530 

Fruits 

48 

A  study  of  this  table  reveals  the  fact  that  the  greatest  quantities  of 
animal  foods  were  consumed  by  the  students'  clubs  in  Maine,  Missouri 
and  Connecticut,  and  the  least  in  Tennessee.  The  consumption  of  carbo- 
hydrate foods  was  largest  in  Maine  and  least  in  Connecticut.  It  will  be 
noticed  also  that  the  students  in  Connecticut  and  Maine  consumed  a  larger 
proportion  of  beef  than  was  used  by  the  students  in  Tennessee  or  Missouri. 
In  the  latter  state  the  students  consumed  a  noticeably  large  amount  of 
pork.  While  in  Maine  poultry  and  fish  comprised  a  large  part  of  the 
animal  food,  these  were  little  used  in  the  colleges  in  Tennessee  and  ]\Iis- 
souri.  Milk  formed  a  conspicuous  percentage  of  the  diet  in  the  schools 
of  Missouri,  Connecticut  and  Maine,  while  in  Tennessee  it  was  used  spar- 
ingly. The  dietary  of  the  student  clubs  in  Maine  seems  to  be  much  more 
generous  in  all  respects  than  the  others.  In  Tennessee  the  average  of  five 
student  clubs  was  92  grams  of  protein,  yielding  3,545  calories  of  energy; 
38  per  cent  of  the  food  value  was  obtained  from  animal  food  and  02  per 
cent  from  vegetable  food.  In  Missouri  the  average  of  three  student  clubs 
was  96  grams  of  protein,  the  menu  yielded  3,560  calories  of  energy,  and 
the  food  value  was  about  equally  divided  between  the  animal  and  vegetable 
kingdoms.  In  Connecticut,  of  5  student  clubs  the  average  was  106  grams 
of  protein,  the  ration  yielding  3,280  calories  of  energy,  53  per  cent  of 
which  was  furnished  by  animal  food  and  47  by  vegetable  food.  In  Maine, 
the  average  of  5  student  clubs  was  121  grams  of  protein,  the  menu  yield- 
ing 4,260  calories  of  energy,  40  per  cent  of  which  was  furnished  by  animal 
food  and  00  per  cent  by  vegetable  food.  Although  those  dietaries  do  not 
portray  the  actual  dietaries  of  the  people  in  the  sections  of  the  country 


376  DIET    IX    HEALTH 

where  these  schools  are  located,  yet  they  may  be  accepted  as  an  approximate 
criterion  of  the  usual  dietary  of  the  inhabitants  of  the  various  sections. 

Mechanics  and  Laborers.  — The  dietary  of  most  mechanics  in  the  United 
States  affords  them  from  100  to  150  grams  of  protein,  and  yields  from 
3,000  to  5,000  calories  of  energy.  A  list  of  occupations  requiring  a  great 
expenditure  of  energy  and  the  necessary  energy  required  expressed  in 
calories  will  be  found  by  referring  to  previous  pages  in  this  chapter. 
It  is  not,  after  all,  such  a  formidable  task  to  reckon  the  caloric  value  of  a 
meal.  For  instance,  take  the  principal  meal  (dinner)  of  a  laborer  or 
mechanic:  roast  beef,  100  calories;  bread,  150  calories;  butter,  150 
calories;  rice,  128  calories;  baked  potato,  100  calories;  bread  pudding, 
128  calories;  sugar  and  cream  with  coffee,  100  calories;  total,  960  calories, 
about  one-third  of  the  day's  requirements.  A  meal  of  this  composition  is 
over-rich  in  protein,  but  the  balance  would  be  restored  by  lack  of  protein 
and  an  excess  of  green  vegetables  and  fruits  at  the  other  two  meals.  It 
will  be  taken  into  consideration  that  the  ordinary  portions  of  these  sub- 
stantial foods  average  about  100  calories.  When  extra  strenuous  effort 
is  put  forth  in  an  occupation,  the  portions  of  bread  and  potatoes,  butter 
and  rice  can  be  increased  and  easily  raise  the  meal  to  the  energy  require- 
ment without  adding  to  the  main  protein  ration,  whatever  it  may  be — 
meat,  cheese,  chicken  or  fish.  If  a  laborer  has  been  subjected  to  strenu- 
ous exercise  and  is  hungry,  allow  him  to  fill  up  on  non-protein  elements  of 
the  meal,  help  him  to  more  potatoes  and  vegetables  or  simple  pudding, 
instead  of  increasing  the  animal  foods. 

It  has  been  found  in  the  South  that  cornbread  and  molasses  will  fur- 
nish the  necessary  energy  to  carry  a  negro  through  a  cold  day.  If  he 
works  hard,  he  will  burn  it  up  completely,  and  there  will  be  no  ashes  as 
would  be  the  case  if  he  overate  of  meat  or  other  protein.  Late  researches 
tend  to  prove  that  the  protein  elements  can  be  stored,  at  least  for  a  short 
period  of  time,  in  the  tissues ;  but  such  a  storage  is  more  or  less  dangerous 
from  the  extra  strain  put  on  the  liver  and  kidneys  to  excrete  the  waste. 
Carbonaceous  foods — sugar,  starches  and  fats — can  be  stored  in  the  form 
of  tissue  fats. 

The  average  human  body  weighing  154  pounds  should  have  about  six- 
tenths  of  its  heat  or  fuel  imits  supplied  from  carbohydrates,  sugar,  pota- 
toes, bread,  cereals  and  vegetables;  three-tenths  should  be  supplied  by 
fats,  butter,  oils,  cream  or  meat  fats — the  last  being  the  least  desirable 
form  in  which  this  element  may  be  supplied.  These  energy  or  fuel  foods 
should  be  increased  in  quantity  in  proportion  to  the  energy  expended  in 
strenuous  exercise  or  in  the  performance  of  hard  work. 


DIET    STUDIES 


377 


It  has  always  been  recognized  by  scientific  men  that  the  allowance  of 
food  should  be  in  proportion  to  the  work  the  body  is  expected  to  do.  Play- 
fair  (12),  who  has  given  this  subject  a  great  deal  of  attention,  has  worked 
out  a  table  with  the  corresponding  amounts  of  matter  and  energy  ixi  grams 
and  calories,  estimated  by  Rubner's  factors. 

PLAYFAIR'S  TABLE  OF  REQUIREMENTS  FOR  WORK 


Subject  and 
Condition 


Subsistence  diet 

Model  ate  work 

Soldiers:  During  peace 

Infantry  in  the  field . 

Royal  Engineers  in 

the  field 

English  sailors 

Navy 

Prisoners :  Under  7  days 

Under  21  days 

Light  labor 

Industrial  labor .... 

Hard  labor 

Undergoing  punish- 
ment  


03    N 

o    - 

SO 

d 

M 

H 

> 

Pt 

^  CO 

-go 

■S  aT 

2.230 

.840 

11.69 

2,453 

63.25 

22.0 

330 

4.075 

1.557 

18.80 

1.963 

4,072 

115.00 

44.0 

534 

14.00 

4.215 

1.397 

18.69 

.714 

4,026 

120.00 

40.0 

510 

19.25 

5.410 

2.410 

17.92 

.680 

4,458 

154.00 

68.0 

610 

19.07 

5.080 

2.910 

22.25 

.930 

5,232 

144.00 

82.5 

610 

26.36 

5.000 

2.370 

14.39 

3,911 

142.00 

65.0 

410 

5.640 

2.340 

20.41 

4,839 

160.00 

67.0 

578 

1.800 

.480 

10.71 

1,938 

51.00 

14.0 

304 

2.448 

.608 

14.80 

2,650 

68.00 

17.0 

425 

3.508 

.315 

16.72 

1.715 

3,577 

100.00 

9.0 

470 

50.00 

3.710 

1.562 

17.31 

1.616 

3,787 

105.00 

44.0 

495 

46.00 

4.075 

1.557 

18.80 

1.963 

4,072 

116.00 

44.0 

534 

14.00 

1.296 

.256 

8.16 

.368 

1,541 

36.00 

7.1 

230 

10.60 

WO 


1,820 
3,070 
3,037 
3,374 

3,858 
3,067 
3,650 
1,626 
2,179 
2,420 
2,870 
3,075 

1,154 


Many  physiologic  investigators  have  devoted  considerable  time  and 
research  to  determine  the  alimentation  consumed  by  individuals  who  were 
allowed  a  "free  choice  of  food,"  and  have  come  to  the  conclusion  that  the 
dietaries  having  the  food  value  given  in  Playfair's  table  would  furnish  a 
nutrition  that  was  fairly  normal  and  that  the  nitrogen  balance  would  be 
kept  in  a  fair  state  of  equilibrium.  The  conclusion  is  that  the  Playfair 
dietaries  represent  fairly  well  the  amount  of  food  required  by  persons 
studied  in  these  tables,  which  we  will  now  compare  with  the  alimentation 
outlined  in  the  table  given  on  page  270.  The  list  of  examples  of  food  con- 
sumed is  compiled  from  data  collected  by  Tibbles(13)  in  Europe,  Asia 
and  America,  and  shows  that  when  Europeans  or  Americans  are  free  to 
choose  their  own  food  they  seldom  select  what  will  yield  less  than  100 
grams  of  protein  per  diem.  When  the  choice  of  food  rests  with  the  indi- 
vidual (American),  he  seldom  partakes  of  less  than  90  grams  of  protein 
per  day.  In  this  country  there  are  many  thousands  of  individuals  who, 
from  force  of  circumstances,  are  necessarily  compelled  to  subsist  on  a 


378 


DIET    m   HEALTH 


dietary  with  a  much  smaller  quantity  of  protein,  because  eggs,  meat,  fish, 
fowl,  milk  and  cheese  are  more  expensive  than  bread,  potatoes,  rice,  oat- 
meal, etc. 

Standard  and  Actual  Dietaries  Compared. — We  will  now  study  the  fol- 
lowing standard  daily  dietaries  as  suggested  by  Hutchison(14),  all  con- 
taining a  high  protein  content,  founded  on  the  investigations  by  At- 
water(15)  : 

DAILY  STANDARD  DIETARIES 

(Food  materials  furnishing  approximately  the  0.28  pound  =  125  grams  of  protein  and 
3,500  calories  of  energy  of  the  standard  for  daily  dietary  of  a  man  of  moderate 

muscular  work.) 


Food  Materials 

Amount 

Total 
Organic 
Matter 

Protein 

Fats 

Carbo- 
hydrates 

Fuel 
Values 

I 
Beef,  round  steak 

Ounces 

13 

3 

6 
22 

Pounds 

0.26 
0.16 
0.17 
0.89 

Pounds 

0.14 

6.02 
0.12 

Pounds 

0.12 
0.16 

0.02 

Pounds 

0.15 
0.75 

Calories 
695 

Butter 

680 

Potatoes 

320 

Bread 

1760 

II 

Pork,  salt 

44 

4 

2 

16 

8 

1.48 

0.21 
0.11 
0.84 
0.33 

0.28 

0.23 
0.04 

0.30 

0.21 
0.11 
0.02 
0.01 

0.90 

6.59 

0.28 

3455 

880 

Butter 

450 

Beans 

1615 

Bread 

640 

Ill 

Beef,  neck 

30 

10 
1 

16 

16 
4 

16 
3 

1.49 

0.19 
0.05 
0.13 
0.17 
0.23 
0.67 
0.19 

0.27 

0.10 

0.04 
0.02 
0.04 
0.09 

0.35 

0.09 
0.05 
0.04 

0.02 
0.02 

0.87 

0.05 
0.15 
0.17 
0.56 
0.19 

3585 
550 

Butter 

255 

Milk,  one  pint 

325 

Potatoes 

320 

Oatmeal 

460 

Bread 

1280 

Sugar 

345 

IV 

Beef,  upper  shoulder 

Ham 

66 

10 
6 
3 
2 
16 
12 
9 
1 

1.63 

0.22 
0.19 
0.05 
0.11 
0.13 
0.12 
0.44 
0.06 

0.29 

0.09 
0.06 
0.03 

6.04 
0.01 
0.05 

0.22 

0.13 
0.13 
0.02 
0.11 
0.04 

0.01 

. . . 

1.12 

0.05 
0.11 
0.38 
0.06 

3535 

800 
650 

Eggs,  two 

135 

Butter 

450 

Milk,  one  pint 

325 

Potatoes 

240 

Flour 

825 

Sugar 

115 

59 

1.32 

0.28 

0.44 

0.60 

3540 

DIET    STUDIES 


379 


DAILY  STANDARD   DIETARIES— Con^muerf 


Food  Materials 

Amount 

Total 
Organic 
Matter 

Protein 

Fats 

Carbo- 
hydrates 

Fuel 
Values 

V 

Sausage 

Ounces 

4 
14 

2 
16 

5 

2 
16 

9 

3 

Pounds 

0.14 
0.07 
0.11 
0.13 
0.26 
0.11 
0.24 
0.33 
0.19 

Pounds 

0.03 
0.07 

6.04 
0.07 
0.01 
0.01 
0.04 

Pounds 

0.11 

6.11 
0.04 
0.01 

6.01 

Pounds 

0.05 
0.18 
0.10 
0.23 
0.28 
0.19 

Calories 
510 

Codfish 

140 

Butter 

450 

Milk,  one  pint 

325 

Beans 

505 

Rice 

205 

Potatoes 

420 

Bread 

640 

Suear 

345 

VI 

Beef 

71 

8 
4 
3 

2K 
1 
16 
8 
2 
9 

13^ 

1.58 

0.18 
0.08 
0.05 
0.13 
0.04 
0.13 
0.09 
0.11 
0.38 
0.69 

0.27 

0.08 
0.04 
0.03 

0.02 
0.04 
0.01 
0.01 
0.05 

0.28 

0.10 
0.04 
0.02 
0.13 
0.02 
0.04 

6.01 

1.03 

0.05 
0.08 
0.10 
0.32 
0.09 

3540 
560 

Mackerel,  salt 

230 

Two  eggs 

135 

565 

Cheese 

130 

325 

Potatoes 

160 

205 

Bread 

720 

Sugar 

175 

55 

1.88 

0.28 

0.36 

0.64 

3205 

The  standard  daily  dietaries  given  are  constructed  from  theoretical 
data  taken  from  Hutchison  on  this  and  the  preceding  page.  It  will  now  be 
interesting  to  make  a  comparative  study  of  these  dietaries  with  the  com- 
position of  ordinary  daily  dietaries  actually  consumed  by  individuals  of 
different  countries,  of  different  social  rank,  following  various  and  sundry 
occupations.  In  the  table  on  pages  378-9,  modified  from  Atwater(16), 
studies  are  compiled  from  a  large  number  of  actual  dietaries. 

On  careful  study  of  the  tables  (pages  380-1)  of  actual  dietaries,  it  will 
be  observed  that  they  conform  closely  to  the  ideal  standard  dietary  on  the 
preceding  page.  Discrepancies  of  course  will  be  noted  here  and  there.  For 
instance,  the  diet  of  the  sewing  girl  in  London  is  altogether  insufficient  for 
bodily  requirements,  while,  on  the  other  hand,  the  diet  of  some  well-to-do 
American  families,  bricklayers,  and  teamsters  is  needlessly  liberal,  espe- 
cially with  the  protein  allowance  (compare  low  protein  allowance  sug- 
gested by  Chittenden ( 17)  in  his  standard  dietary  table  given  in  Volume 
II,  Chapter  VII).    Taking  the  preceding  table  as  a  whole,  it  is  gratifying 


380 


DIET    I^T    HEALTH 


ACTUAL  DIETARIES 


Classes 


Nutritive  Constituents 

Protein 

Fats 

Carbo- 
hydrates 

Total 

Grams 

127 

95 

Grams 
186 
132 

Grams 
531 
481 

Grams 
844 
708 

114 

150 

522 

786 

129 

128 

183 
177 

467 
466 

779 
771 

161 
138 
115 
104 
181 
182 
222 

204 
184 
163 
136 
292 
254 
263 

680 
622 
460 
421 
557 
617 
758 

1,045 

944 

738 

661 

1,030 

1,053 

1,243 

254 
180 
120 
143 
103 

363 
365 
161 
184 
138 

826 
1,150 
454 
520 
436 

1,443 

1,695 

735 

847 
677 

104 

125 

423 

101 

139 

414 

105 

147 

465 

... 

109 

109 

527 

745 

118 

204 

549 

871 

107.7 
115 

63 

73 
100 

88.4 
113 
3 
30 

84 

479.4 

289 

481 

472 

264 

675.5 

155 
53 
52 

GO 

177 
33 
53 

28 

440 
316 
301 

398 

402 
406 
486 

Potential 
Energy 


United  States  Dietaries 
Factory  operatives,  mechanics,  etc.,  Mass. 

Glass-blowers,  E.  Cambridge,  Mass 

Factory  operatives,   dressmakers,   clerks, 

etc.,  boarding-house 

Well-to-do  private  family,  Connecticut: 

Food  purchased 

Food  eaten 

College  students  from  Northern  and  East- 
ern States;  boarding  club,  two  die- 
taries of  the  same  club: 

Food  purchased 

Food  eaten 

Food  purchased 

Food  eaten 

College  football  team,  food  eaten 

Machinist,  Boston,  Mass 

Brick-makers,  Middletown,  Conn 

Teamsters,  marble- workers,  etc.,  with  hard 

work,  Boston,  Mass 

Brick-makers,  Cambridge,  Mass 

U.  S.  Army  ration 

U .  S.  Navy  ration 

Average  of  53  American  studies 

Professional  men  in  America  (average  of 

14  studies) 

Average  of  4  women  students'  clubs  in 

America 

Average   of   16  men   students'   clubs   in 

America 

Canadian  Dietaries 
French    Canadians,    working    people,    in 

Canada 

French    Canadians,    factory    operatives, 

mechanics,  etc 

European  Dietaries 

Average  diet  of  laborer's  family  in  Edin- 
burgh  

Chinese  dentist's  family 

Japanese  professional  man 

Malays  (professional  men) 

Europeans  in  Java  (professional  men) .... 

University  boat  crews  (average  of  7 
studies) 

London,  sewing  girl,  wages  3s.  9d.  per  week 

Leipsic,  Gennany,  factory  girl,  5s.  per  week 

England,  weaver,  time  of  scarcity 


Calories 
4,428 
3,590 

4,002 

4,146 
4,082 


5,345 

4,827 
3,874 
3,417 
5,742 
5,638 
6,464 

7,804 
8,848 
3,851 
4,998 
3,500 

3,325 

3,405 

3,705 


3,622 
4,632 


3,228 
2,705 

2,258 
2,512 
2,470 

4,085 
1,820 
1,940 
3,138 


DIET    STUDIES 
ACTUAL  DIETARIES— Continued 


381 


Classes 


European  Dietaries — Continued 

Lombardv,  Italy,  laborers;    diet  mostly 
vegetable 

Trappist  monk  in  cloister;   very  little  ex- 
ercise, vegetable  diet 

Japan,  students 

Munich,  Gennany,  university  professor, 
very  little  exercise 

Munich,  lawyer 

Munich,  physician 

Leipsic,  Germany,  painter 

Leipsic,  Germany,  cabinet-maker 

England  "fully  fed"  tailors 

Munich,  Germany,  "well-paid"  mechanic. 

Munich,  Germany,  carpenter 

England,  "hard-worked"  weaver 

England,  blacksmith 

Germany,  miners  at  very  severe  work. .  . . 

Munich,   brick-makers   (Italians  at  con- 
tract work) 

Munich,    brewery    laborer,    very    severe 
work,  exceptional  diet 

Gennan  soldiers,  peace  footing 

German  soldiers,  war  footing 

German  soldiers,  Franco-German  War,  ex 
traordinary  ration 

Russian  workmen 

Swedish  workmen  (moderate  labor) 

Swedish  workmen  (hard  labor) 


Nutritive  Constituents 


Protein 


Grams 

82 

68 
97 

100 
80 

131 
87 
77 

131 

151 

131 

151 

176 

133 

167 

223 
114 
134 

157 
132 
134 

189 


Fats 


Carbo- 
hydrates 


Grams 
40 

11 

16 

100 
125 
95 
69 
57 
39 
54 
68 
43 
71 
113 

117 

113 
39 

58 

285 
80 
79 

110 


Grams 

362 

469 
438 


240 
222 
327 
366 
466 
525 
479 
494 
622 
667 
634 

675 

909 
480 
489 

331 
583 
523 
714 


Total 


Grams 

484 

548 
551 


440 
427 
553 
522 
600 
695 
684 
693 
816 
914 
880 

959 

245 
633 
681 

733 


Potential 
Energy 


Calories 

2,192 

2,304 
2,343 

2,324 
2,401 
2,762 
2,500 
2,757 
3,053 
3,085 
3,194 
3,569 
4,117 
4,195 

4,641 

5,692 
2,798 
3,098 

4,652 
3,675 
3,436 
4,726 


to  observe  the  closeness  with  which  the  actual  dietaries  correspond  to  the 
standard.  We  must  not  overlook  the  fact  that  the  standard  dietaries  such 
as  we  have  been  considering  have  only  a  limited  range  of  usefulness.  It 
would  not  be  wise  to  apply  them  rigidly  in  any  particular  case,  since  they 
have  been  formulated  to  meet  the  demands  of  typical  vocations  living 
under  well-known  and  regulated  conditions  and  engaged  in  occupations 
calling  for  only  a  moderate  amount  of  muscular  work.  Still  they  are  of 
value  in  guiding  us  to  formulate  well-balanced  rations  for  persons  who 
have  no  decided  choice  in  their  alimentation,  and  who  are  living  under 
fairly  uniform  regulations — such  as  soldiers,  inmates  of  prisons,  homes 
and  workliouscs.  Besides,  these  studies  furnish  us  with  standard  infor- 
iii:ili(»ii  by  which  to  regulate  well-balanced  rations  for  any  collection  of 
individuals, 


382  DIET    IX    HEALTH 

Col.  ^Melville,  in  discussing  "The  Food  Requirements  for  Sustenance 
and  Work" (18),  reported  before  the  British  Medical  Association  his 
studies  on  the  observation  of  men  doing  a  measured  amount  of  work  with  a 
measured  quantity  of  food. 

Twenty  soldiers  walked  for  periods  of  five  and  six  days  an  average  of  twelve 
to  thirteen  miles,  carrying  their  kit,  the  weight  of  which  averaged  54  pounds 
(24.5  kilos).  The  average  weight  of  the  men  was  141  pounds  (64.15  kilos).  The 
expenditure  of  energy  was  calculated  from  Zuntz's  factors:  For  every  kilo  trans- 
ported horizontally  at  the  rate  of  94  meters  (102  yards)  per  minute  the  exi)endi- 
ture  was  0.0006  calorie;  and  for  every  kilo  raised  1  meter  vertically  the  expenditure 
was  0.0075  calorie;  whence  it  was  determined  that  the  average  expenditure  in 
walking  one  mile  and  carrying  54  pounds  over  an  ordinary  give-and-take  road 
was  90  calories,  and  the  total  daily  expenditure  in  external  or  mechanical  work 
amounted  to  1,034  calories. 

According  to  the  above,  it  will  be  readily  seen  that  the  total  energy 
expended  by  these  men  was  as  follows : 

ENERGY  EXPENDED  BY  MARCHING  SOLDIERS 

(a)  Energy  spent  in  sedentary  occupation  (Zuntz) 2,200  calories 

(b)  Energy  spent  in  work  to  camp  hfe,  and  in  playing  quoits  and  foot- 

ball       800 

(c)  Energy  spent  in  walking  and  carrying  load 1,034        " 


Total  average  daily  expenditure 4,034        " 

The  march  was  done  on  six  days  continuously,  then  one  day's  rest  in- 
tervened before  the  second  period  of  five  days'  walking  completed  the 
work  done.    The  food  consumed  was  as  follows : 

FOOD  CONSUMED  BY  EACH  SOLDIER  PER  DAY 

First  Week     Second  Week  Average 

Proteins 190  grams           145  grams  168  grams 

Carbohydrates 510      «               450      "  480      « 

Fat 58      «               110      «  84      « 

Calories 3,426      "            3,503      «  3,481      " 

Unavoidable  waste,  10  per  cent:  net  calorific  value,  3,140. 

A  careful  examination  of  the  above  tabulation  by  Melville  (19)  em- 
phasizes the  fact  that  there  was  a  deficiency  of  890  calories  in  the 
alimentation. 

Negroes  and  Poor  Mexicans. — Atwater  and  Wood (20)  call  special  at- 
tention to  the  fact  that  "our  dietary  is  out  of  balance,"  and  aver  that  "the 
one-sidedness  is  greater  in  the  South  than  in  the  North,"  by  which  they 
mean  that  the  ratio  between  protein  and  calories  is  greater  than  it  should 
be.  The  table  on  page  384  gives  data  with  reference  to  the  protein  recpiire- 
ment  of  the  diet  of  both  men  and  women  in  various  occupations.     Hpff- 


DIET    STUDIES  383 

man,  in  writing  on  the  diet  of  tlio  Southern  ncgToes(21),  emphasizes  the 
point  that  the  negroes  of  the  Southern  States  subsist  on  an  unvaried  diet, 
consisting  either  of  staple  foods  of  fat,  salt  pork,  corn  meal  and  molasses, 
and  that  witli  them  cooking  is  most  primitive.  The  following  from  Hoff- 
man's views  on  the  subject  is  of  interest : 

The  daily  fare  is  prepared  in  very  simple  ways.  Corn  meal  is  mixed  with 
water  and  baked  on  the  flat  surface  of  a  hoe  or  griddle.  The  salt  pork  is  sliced 
thin  and  fried  until  very  brown  and  much  of  the  grease  fried  out.  Molasses 
from  cane  or  sorghum  is  added  to  the  fat,  making  what  is  known  as  "sop,"  which 
is  eaten  with  the  corn  bread.  Hot  water  sweetened  with  molasses  is  used  as  a 
beverage.  This  is  the  bill  of  fare,  three  times  a  day  during  the  year,  of  most  of 
the  cabins  on  the  plantations  of  the  "black  belt."  It  is,  however,  varied  at  times; 
thus,  collards  and  turnips  are  boiled  with  the  bacon,  the  latter  being  used  with  the 
vegetables  to  supply  fat,  "to  make  it  rich."  The  corn-meal  bread  is  sometimes 
made  into  so-called  "craeklin  bread,"  and  is  prepared  as  follows:  A  piece  of 
fat  bacon  is  fried  until  it  is  brittle;  it  is  then  crushed  and  mixed  with  corn  meal, 
water,  soda  and  salt  and  baked  in  an  oven  over  the  fireplace.  Occasionally,  the 
negroes  may  have  an  opossum.  To  prepare  this  for  eating  it  is  first  put  into  hot 
water  to  help  in  removing  a  part  of  the  hair,  then  covered  with  hot  ashes  until 
the  rest  of  the  hair  is  removed;  thereupon  it  is  put  in  a  large  pot,  surrounded 
with  sweet  potatoes,  seasoned  with  red  pepper,  and  baked.  One  characteristic 
of  the  cooking  is  that  all  meats  are  fried  or  otherwise  cooked  until  they  are  crisp. 
Observation  among  these  people  reveals  the  fact  that  very  many  of  them  suffer 
from  indigestion  in  some  form. 

Arthur  Goss(22),  in  writing  on  the  dietary  standards  of  the  Alabama 
negroes,  makes  a  comparison  of  their  diet  with  that  of  the  Mexicans  of  New 
Mexico,  and  the  following  from  his  observations  is  of  interest  in  this 
connection : 

Mexicans  of  the  poorer  class  raise  the  greater  part  of  their  food,  which  is 
a' nost  entirely  of  vegetable  origin.  Flour  and  corn  are  used,  the  relative  amounts 
depending  upon  the  amount  of  money  available.  If  it  is  necessary  to  reduce  the 
cost  of  living  to  the  minimum,  as  is  often  the  case,  more  corn  and  less  flour  is  used. 

P:obably  the  next  article  in  ajnount,  and  a  very  important  one,  is  the  native 
bean  or  "frijole"  (Phaseolus  sp.),  which,  together  with  peas  and  lentils,  is  used 
to  supply  the  protein  necessary  in  the  absence  of  meats  and  other  nitrogenous 
foods  of  animal  origin. 

Another  universal  article  in  the  Mexican  diet  is  red  pepper,  or  "chili,"  which, 
while  it  constitutes  comparatively  a  rather  snuill  proportion  by  weight  of  the 
total  food,  is  still  consumed  in  enormous  quantities  as  compared  with  the  use  of 
such  material  by  the  people  of  the  eastern  states.  Chili  is  probably  used  more 
for  its  stimulating  effect  on  the  digestive  organs  than  for  the  actual  amount  of 
nutrients  which  it  furnishes. 

In  point  of  cost,  probably  the  most  important  article  used  by  the  Mexicans 
not  home  produced  is  coffee.  Ljird  is  another  very  important  article  which  is 
usually  purchased,  and  which  is  used  in  considerable  quantities.     As  the  vege- 


384 


DIET    IX   HEALTH 


table  foods  used  contain  very  little  fat,  it  is  necessary  to  increase  the  amount  of 
this  substance  by  addition  from  outside  sources,  usually  either  lard  compound  or 
beef  tallow,  which  are  the  cheapest  forms  of  fat  in  this  region. 

In  the  houses  of  the  poorer  class  the  cooking  is  done  in  an  open  fireplace, 
usually  located  in  one  corner  of  the  room. 

The  "tortillas"  (23),  or  cakes  made  from  flour  or  ground  corn,  are  one  of 
the  most  generally  and  extensively  used  foods.  When  the  tortillas  are  made  from 
com,  the  kernels  are  first  boiled  with  lime,  which  softens  them.  The  skin  is 
then  usually,  though  not  always,  removed,  and  the  grain  is  ground  in  a  crude 
stone  grinding  apparatus,  or  "metate,"  consisting  of  a  concave  slab  of  stone  and 
a  smaller  convex  piece,  which  is  held  in  the  hands  and  which  serves  as  a  pestle. 
The  grinding  is  not  rotary,  however,  as  in  an  ordinary  mortar,  but  up  and  down, 
toward  and  from  the  body.  The  corn  used  is  usually  a  small  blue  kind,  rather 
soft,  which  seems  to  contain  somewhat  more  than  the  average  amount  of  fat. 
After  the  corn  has  been  ground  into  a  mush  on  the  metate,  it  is  patted  out  in 
the  hands  into  the  tortillas.  Com  tortillas  are  never  rolled,  as  is  the  case  with 
those  made  from  flour.  If  flour  is  used,  it  is  mixed  into  a  dough  with  water  and 
the  cake  rolled  out  from  it.  The  flour  used  is  not  ground  in  the  metate,  but  in 
the  ordinary  flouring  mills.  It  is  usually  of  poor  quality,  coarse  and  dark  colored. 
After  being  worked  into  the  proper  form,  the  tortilla  is  baked  on  a  flat  piece  of 
iron,  supported  directly  over  the  fire  in  the  open  fireplace,  the  iron  being  first 
greased  with  lard.  As  soon  as  it  is  done  on  one  side  the  tortilla  is  turned  by 
pressing  the  moistened  fingers  against  the  upper  side  of  it,  thus  causing  it  to 
adhere  to  the  fingers,  whereupon  it  is  deftly  turned  and  the  opposite  side  is 
browned. 

The  frijoles,  or  beans,  are  cooked  in  small,  home-made  earthenware  pots,  and 
are  almost  invariably  combined  with  a  very  liberal  proportion  of  chili  and  also 
with  a  considerable  amount  of  lard. 

DAILY  DIETARY  OF  NEGRO  FARMER  AND  POOR  MEXICAN 


Protein 


Fat 


Carbo- 
hydrate 


Calories 


Negro  farmer:  Animal . .  . 

Vegetable. 
Same:  Animal. .  . 

Vegetable. 
Same:  Animal. .  . 

Vegetable. 
Poor  Mexican :  Animal . . . 

Vegetable. 
Same:  Animal... 

Vegetable 
Same:  Animal... 

Vegetable 
Same:  Animal... 

Vegetable 


Grams 
52 
40 
2 
42 
26 
33 

107 

93 
4 

82 
29 

72 


Grams 

119 

5 

41 

16 

74 

11 

56 

19 

61 

19 

49 

23 

60 

7 


Grams 

65 
360 

372 

26 

403 

713 

644 

57i 

572 


1585 
3270 

395 
1845 

900 
1890 

520 
3540 

565 
3200 

470 
2890 

680 
2705 


USE    OF    ALCOHOL  385 

The  chili  is  cooked  alone,  and  also  with  various  other  articles  of  food.  It  is 
prepared  by  first  removing  the  stems  and  seeds  of  the  pods,  which  constitute 
somewhat  more  than  half  of  the  total  weight,  after  which  it  is  sometimes  ground 
in  the  metate,  but  is  usually  soaked  in  water  and  the  inner  or  edible  portion 
separated  from  the  outer  skin  by  squeezing  in  the  hands.  Owing  to  the  extremely 
strong  irritating  effect  on  the  hands,  this  operation  cannot  be  performed  by  an 
amateur.  The  Mexican  women,  however,  become  so  accustomed  to  it  that  it  seems 
to  have  no  effect  on  them. 

Among  the  poor  families  the  meals  are  served  on  the  floor  in  the  middle  of 
the  room,  the  family  sitting  on  the  ground  around  the  food  and  eating  without 
knives,  forks  or  plates. 

The  exceedingly  small  amount  of  animal  food  consumed  by  some  of 
the  negro  families  studied  by  Hoffman,  and  its  entire  absence,  except  as 
represented  by  lard,  in  some  of  the  Mexican  families  as  studied  by  Goss, 
are  shown  in  the  table  on  the  preceding  page.  This  research  shows  a  suf- 
ficient source  of  heat  units  obtained  from  vegetable  fuel  foods,  but  at  the 
same  time  it  shows  an  insufficiency  of  protein,  most  of  which  is  derived 
from  vegetable  foods  and  in  some  instances  altogether  so.  For  the  sake 
of  comparison,  consult  the  Standard  Dietary  as  outlined  by  Chit- 
tenden (17). 

USE  OF  ALCOHOL 

A  healthy  normal  individual  does  not  need  alcohol.  As  a  beverage 
it  undoubtedly  exerts  harmful  influences  upon  the  human  economy.  It  is 
absolutely  unnecessary  in  health,  but  it  is  so  extensively  employed  in  all 
parts  of  the  world  either  to  produce  fictitious  exhilaration  or,  by  lessening 
sensibility,  to  mitigate  fatigue  and  discomfort,  sorrow  and  suffering,  and 
it  has  been  so  largely  and  so  injudiciously  used  in  disease,  that  it  demands 
some  consideration.  (See  also  Volume  I,  Chapter  XVT,  "Beverages 
and  Stimulants").  Its  habitual  use  prods  the  heart  to  greater  activity. 
Richardson,  writing  on  the  subject,  says:  "One  ounce  of  alcohol  daily  will 
increase  the  heart  beats  430 ;  2  ounces,  1,872 ;  4  ounces,  12,960  ;  6  ounces, 
30,070."  But  while  increasing  the  rate  of  the  heart,  it  weakens  the  fdrce 
so  that  the  final  result  is  to  lower  the  blood  pressure.  In  other  words, 
while  the  heart  seems  to  be  stimulated,  it  is  really  weakened.  It  is  not 
surprising  therefore  that  a  period  of  enfeeblement  of  this  organ  follows 
the  habitual  use  of  alcohol. 

The  use  of  alcohol  does  not  increase  muscular  energy,  but  on  the  other 
hand  fatigue  is  hastouod  by  it.  Its  effect  on  individuals  varies  groatlv; 
some  show  ill  effects  on  small  doses  and  others  are  seemingly  resistant  to 
large  ones.     Some  people  are  stimulated  by  it  to  eat  more  heartily  and  to 


386  DIET    m   HEALTH 

put  forth  less  muscular  exertion,  and  since  oxidation  goes  on  more  slowly 
in  these  individuals,  they  easily  accumulate  fat,  but,  although  they  may 
appear  plump  and  full  fed,  they  are  not,  as  a  rule,  resistant  to  disease  nor 
capable  of  prolonged,  strenuous,  muscular  exertion.  Its  habitual  use  is  of 
no  advantage  in  normal  health,  while  those  who  are  not  strong-willed  or 
self-control  led,  and  those  who  inherit  a  love  for  liquor  or  have  a  tendency 
to  inebriety,  gout,  arteriosclerosis,  or  other  degenerative  changes,  will  be 
far  better  without  it.  It  is  true,  many  persons  can  use  it  in  strict  modera- 
tion without  apparent  harm;  the  majority,  however,  sooner  or  later  awake 
to  the  realization  that  even  with  moderation  they  are  not  so  well  when 
they  use  it  habitually.  The  continued  and  habitual  use  of  alcoholic  bev- 
erages invariably  exerts  a  harmful  influence  on  the  human  organism. 
The  wisdom  or  folly  of  their  use  in  health  is  not  a  question  that  the 
physiologist  alone  can  determine.  The  ease  with  which  the  habit  of  im- 
bibing spirituous  liquors  grows  to  an  excess,  and  the  harmful  influences 
exerted  by  them  on  the  body  politic,  make  the  desirability  of  their  use  a 
social  problem  as  well  as  a  physiological  one. 

Since  alcohol  is  really  a  narcotic  and  not  a  stimulant  at  all,  and  since 
it  is  not  a  food  in  any  real  scientific  sense,  it  need  not,  therefore,  be 
further  discussed  under  the  present  caption :  "Diet  in  Health." 

DIET    IN    TROPICAL    CLIMATES(24) 

It  has  been  generally  taught  that  in  tropical  climates  a  smaller  amount 
of  nitrogenous  food  is  required  than  in  the  temperate  zones.  Of  course, 
it  must  be  premised  that  the  natives  of  tropical  lands  are  better  fitted 
physically  and  physiologically  to  withstand  excessive  heat  and  the  actinic 
rays  of  the  sun  in  hot  climates  than  are  the  white  men  who,  as  a  rule,  are 
only  sojourners.  But  even  in  the  case  of  natives,  the  long-hold  ideas  tliat 
"they  should  eat  the  kind  of  food  which  is  habitual  with  them  Wause  it 
best  suits  their  requirements,"  are  lapsing  into  sometliing  like  disrepute. 
In  fact,  within  recent  years  opinions  as  to  diet  in  the  tropics  both  for 
natives  and  for  white  men  have  changed  very  considerably. 

General  Considerations. — We  will  present  herewith  the  views  of  various 
authorities  on  the  subject,  and  then  endeavor  to  sift  the  evidence  or  leave 
it  to  our  readers  to  form  their  own  opinions.  The  late  Dr.  Charles  Wood- 
ruff (25),  a  man  of  very  decided  views  and  one  who  was  not  afraid  to 
express  them,  however  much  they  might  clash  with  those  of  other  observ- 
ers, delivered  himself  somewhat  as  follows  with  respect  to  diet  in  hot 
climates.     '•'It  used  to  be  an  article  of  faith  in  physiology,  that  wherever 


DIET    IN    TROPICAL    CLIMATES  387 

we  go  in  the  world  we  should  imitate  the  natives  in  food,  clothing,  houses 
and  methods  of  work.  Upon  acquaintance  with  the  native  we  found  him 
poverty  stricken,  weak,  undersized,  even  half  starved,  badly  housed,  filthy, 
diseased,  and  of  such  lack  of  vitality  as  to  average  less  than  fifteen  years  of 
life.  To  imitate  him,  as  our  physiologists  taught,  was  merely  to  die  twenty 
or  twenty-five  years  before  our  time."  According  to  Woodruff,  false  notions 
are  now  gradually  disappearing  in  the  light  of  new  facts.  Take,  for  exam- 
ple, the  matter  of  meat  in  the  tropics.  The  orthodox  theory  was  that  we 
must  cut  down  animal  foods  below  the  limit  found  necessary  at  home, 
because,  forsooth,  the  native  dying  of  nitrogen  starvation  could  not  get  as 
much  as  he  should.  The  theory  was  put  into  practice  with  disastrous 
results,  and  nowadays  every  army  oflicer  knows  that  to  avoid  the  awful 
exliaustions  caused  by  tropical  climates  and  the  consequent  infections, 
such  as  tuberculosis,  etc.,  we  must  have  as  much  animal  food  as  we  have  at 
home,  or  even  more. 

Perhaps  Woodruff  was  inclined  to  exaggerate  the  value  of  nitrogenous 
food  in  the  tropics,  but  there  are  many  who  have  had  experience  in  the 
Philippines  and  in  India  who  hold  views  very  much  to  his  way  of  think- 
ing. At  any  rate,  the  old-time  conception  that  nitrogenous  food  was  con- 
tra-indicated in  the  tropics  has  been  almost  exploded. 

Lukis  and  Blackham(26)  uphold  the  teaching  that  in  cold  climates 
the  fats  should  be  increased  and  in  warm  climates  the  carbohydrates.  Yet 
they  do  not  insist  on  a  vegetarian  diet  for  white  men  or  natives.  They 
point  out  in  support  of  the  argument,  that  fats  are  not  suitable  for  con- 
sumption in  hot  climates,  that,  while  butter  is  eaten  with  avidity  in  the 
temperate  zone,  butter  or  fats  of  any  description  are  regarded  with  dis- 
taste in  the  plains  of  India.  These  same  authorities  are  not  in  accord 
with  Chittenden's  views,  that  the  current  estimations  of  the  amount  of 
protein  and  total  fuel  value  necessary  for  hard  work  are  excessive,  and 
they  draw  attention  to  the  fact  that  the  most  recent  researches  fail  to 
agree  with  these  opinions. 

In  any  climate,  the  body  seeks  to  maintain  a  reserve  supply  of  nitrog- 
enous food  for  its  cells.  Consequently,  a  man  having  a  small  reserve 
supply  may  be  considered  on  a  low  plane  of  nutrition,  and,  per  contra,  one 
with  a  large  reserve  supply  may  be  regarded  as  on  a  high  plane  of  nutri- 
tion. It  also  stands  to  reason  that  those  on  a  high  plane  are  better  able 
than  those  on  a  low  plane  to  resist  those  infectious  diseases  which  are  more 
or  less  prevalent  in  the  tropics,  as  bubonic  plague,  cholera,  tuberculosis, 
pneumonia,  typhoid  fever,  typhus,  relapsing  fever  and  plague.  It  would 
seem  to  follow,  in  the  regular  order  of  things,  that  white  men  in  the 


388  DIET    lis    HEALTH 

tropics  not  well  fed  on  nitrogenous  food  should  readily  fall  victims  to 
infectious  diseases.  And  this  is  exactly  what  happens.  They  have  placed 
themselves  from  the  dietetic  standpoint  on  a  level  with  the  natives,  and 
like  them  suffer  from  a  lowered  vitality,  which  renders  them  exceedingly 
susceptible  to  infection  and  liable  to  succumb  to  the  -same,  while  their  wiser 
or  more  fortunate  meat-eating  brothers  are  easily  able  to  resist. 

The  argument,  then,  that,  because  the  natives  of  the  tropics  eat  little 
nitrogenous  food,  white  men  should  follow  suit,  will  not  bear  close  dissec- 
tion. The  natives  do  not  consume  nitrogenous  food  for  the  very  sufficient 
reason  that,  as  a  rule,  they  are  not  able  to  procure  it.  As  referred  to 
previously,  a  large  proportion  of  the  natives  are  in  a  state  of  chronic  star- 
vation, and  it  would  be  the  height  of  folly,  in  the  opinion  of  Lukis  and 
B]ackliam(2fi),  to  place  white  men  in  a  similar  position.  These  writers 
claim,  and  doubtless  with  good  reasoning,  that  the  comparative  immunity 
of  Englishmen  to  the  infectious  diseases  that  decimate  the  natives  of  India 
is  due,  in  part  at  least,  to  their  being  better  fed  on  nitrogenous  food. 
Major  McCay^  has  been  engaged  during  the  past  few  years  in  experi- 
mental research  into  the  question  of  the  effect  of  a  nitrogenous  diet,  and 
in  his  final  report  shows  in  a  decisive  manner  that,  other  things  being 
equal,  diet  is  an  all-important  factor  in  determining  the  degi'ee  of  physical 
development  and  general  well-being  of  a  people,  and  that  with  a  low  level 
of  nitrogenous  interchange,  deficient  stamina  morally  and  physically  must 
be  expected. 

It  is  obvious  that  in  the  performance  of  manual  labor  the  same  expen- 
diture of  energy  is  required  in  every  climate,  but,  as  Tibbles(13)  points 
out,  because  the  climate  influences  the  radiation  of  heat  from  the  body, 
and  that  this  radiation  is  greater  in  a  cold  or  wet  climate  and  less  in  a  hot 
than  in  a  temperate  climate,  more  food  is  needed  in  a  cold  than  in  a  hot 
climate.  However,  this  is  considerably  modified  by  circumstances.  In 
civilized  countries,  and  especially  in  America,  the  greater  loss  of  heat  in 
a  cold  climate  is  prevented  by  heating  the  houses  and  by  wearing  warm 
clothes,  and  the  radiation  of  heat  and  evaporation  from  the  body  in  a  hot 
climate  is  promoted  by  wearing  thin  clothing.  Although  body  metabolism 
is  slightly  decreased  by  the  greater  heat  of  tropical  climates,  the  produc- 
tion of  heat  is  really  not  much  less  than  in  a  temperate  climate.  Where- 
fore the  conclusion  has  been  reached  that  it  is  well  not  to  take  less  food  in 
hot  climates,  but  to  increase  slightly  the  intake  of  carbohydrates  in  order 
to  supply  the  heat  radiated  from  the  skin,  and  with  the  special  object  of 
promoting  perspiration.     Tibbies,  however,  doubts  whether  it  is  good  ad- 

1  Professor  of  Physiology  at  Calcutta  Medical  College. 


DIET    m    TROPICAL    CLIMATES  389 

vice  for  white  men  who  make  tlieir  homo  in  the -tropics  to  follow  the 
dietetic  habits  of  the  natives  and  eat  a  comparatively  very  small  quantity 
of  animal  food  and  large  amounts  of  vegetables  and  fruits.  From  long 
centuries  of  usage  in  hot  climates,  the  natives  are  accustomed  to  consume 
such  large  quantities  of  rice,  pulse  and  other  vegetables  as  a  person  unused 
to  such  food  would  be  positively  unable  to  take  and  to  digest.  The  fact 
must  also  be  taken  into  accoimt  that  there  should  be  a  fairly  definite  ratio 
between  the  proportion  of  nitrogen  and  carbon  in  the  alimentation.  The 
natives  of  India  are  not  influenced  by  poverty  alone  in  their  choice  of 
food.  !Not  only  does  necessity  impel  very  large  numbers  of  them  to  con- 
sumo  materials  from  the  vegetable  kingdom,  but  many  are  bound  by 
religious  scruples  to  avoid  meat.  To  most  of  the  millions  of  India  the  ox 
is  sacred.  The  hog  is  anathema  maranatlia  to  the  Hindus  and  the  Mo- 
hammedans, as  it  was  to  the  Egyptians  of  old  and  to  the  Hebrews  of  the 
present  day  (27).  Some  Hindus  are  strictly  vegetarians,  some  take  no 
animal  food  but  a  little  milk  and  ghee,  while  others  indulge  in  eggs,  fish 
and  game.  The  Sikhs  eat  mutton  and  goat  flesh.  The  Hindus  of  Punjab 
eat  no  meat,  but  the  Mohammedans  living  in  the  same  region  eat  meat 
to  a  certain  extent. 

It  may  be  said  that  evidence  seems  to  show  that  those  natives  who  eat 
meat  are  finer  and  stronger  specimens  of  humanity  than  those  who  desist 
from  flesh  consumption.  Indeed,  the  Sikhs,  who  eat  mutton  and  goat's 
flesh,  are  models  of  good  physique  and  are  easily  the  most  vigorous  race 
physically  of  the  inhabitants  of  India.  !N^evertheless,  it  may  be  pointed 
out  that  the  variations  of  climate  in  India  are  considerable  and,  as  Sir 
Ilavolock  Charles  aptly  says,  "it  is  impossible  to  formulate  exact  rules  for 
dietary  in  the  tropics  generally  because  the  differences  of  climate  entail 
moflifications."  While  the  same  authority  says  nothing'  with  regard  to 
limiting  the  consumption  of  moat,  he  does  say  that  "no  cold  meat  whatever 
should  come  on  the  table,"  and  that  it  is  important  that  everything  should 
come  straight  from  the  fire  to  the  table,  for  then  it  cannot  serve  as  a  carrier 
of  disease  germs  or  parasites,  and  there  need  be  no  fear  of  cholera  or  dys- 
entery. Boiled  water  only  should  be  drunk,  and  no  salads  of  any  kind 
should  be  used  except  with  the  greatest  moderation. 

Fruits  and  Vegetables. — As  for  fruit,  that  kind  which  possesses  a  rind 
that  can  be  removed  may,  according  to  Tibbies,  be  eaten  with  impunity 
by  a  healthy  man  at  any  time  of  the  year.  On  the  other  hand,  fruits 
without  a  rind  or  peeling  are  incapable  of  being  thoroughly  cleansed  and 
in  consequence  may  bo  contaminated  and  dangerous  to  the  consumer  unless 
cooked  before  eating.     "Following  this  rule,  oranges,  grapefruit,  pears, 

125 


390  DIET    IN    HEALTH 

apples,  bananas,  mangoes,  pineapples,  enstard  apples,  mangosteen,  toma- 
toes, etc.,  may  be  eaten  raw  after  having  been  peeled,  but  grapes,  currants, 
strawberries  and  those  fruits  which  cannot  be  peeled  are  on  the  taboo  list 
until  they  have  been  cooked.  Vegetables,  such  as  cabbage,  cauliflower, 
kidney  beans,  green  peas,  pumpkins  and  vegetable  marrow,  should  be  eaten 
fresh  boiled. 

It  can  be  stated,  broadly  speaking,  that  the  alimentary  principles  are 
the  same  in  the  tropics  as  elsewhere,  and,  according  to  Simpson  (28),  the 
simple  and  for  the  most  part  vegetable  diet  of  the  indigenous  inhabitants 
of  the  Tropics  contains  the  same  nutrient  principles  as  the  more  complex 
and  varied  admixtures  of  animal  and  vegetable  foodstuffs  which  form  the 
ordinary  diet  of  races  living  in  colder  climates  under  a  modern  civiliza- 
tion. In  Europe,  meat  chiefly  supplies  the  protein  in  the  food ;  bread,  po- 
tatoes, etc.,  the  carbohydrates ;  and  butter  the  fat ;  while  in  tropical  lands, 
the  protein  in  the  food  is  supplied  mainly  by  fish,  peas,  beans  and  other 
legumes ;  the  carbohydrates  by  millet,  cereals,  manioc,  yams,  etc.,  and  the 
fat  by  vegetable  oils  such  as  ground  nut  and  olive  oil.  Butter  ghee,  of 
animal  origin,  is  clarified  butter  made  from  the  oil  from  the  liver  of  fish 
and  the  fat  of  beef  and  mutton.  It  is  a  good  butter,  but  its  peculiar  flavor 
renders  it  distasteful  to  a  European  palate.  The  vegetable  oils  are  ex- 
pressed from  various  seeds  and  are  used  either  for  cooking  purposes  or  in 
place  of  butter. 

Vegetable  foods  are  represented  by  cereals,  pulses,  tubers,  herbaceous 
vegetables  and  fruits.  Of  roots  and  tubers,  the  chief  are  the  sweet  potato, 
the  yam,  the  tars  and  the  cassava  or  manioc.  According  to  Simpson,  there 
is  in  the  roots  less  than  1  per  cent  of  protein  and  of  fat,  and  their  food 
value  consists  in  the  potash  salts  and  the  amount  of  starch  which  they  con- 
tain, the  latter  constituent  varying  from  15  to  nearly  30  per  cent ;  tapioca 
contains  about  86  per  cent  of  starch.  Rice,  ragi,  millet,  maize,  and  other 
cereals  form,  as  a  rule,  the  staple  foods  of  the  tropics.  They  contain  too 
small  proportions  of  protein  and  oil  to  furnish  sufficient  protein  by  them- 
selves, and  consequently  their  deficiencies  are  made  up  by  an  admixture 
of  a  small  quantity  of  legumes.  The  pulses  or  peas  and  beans  are  particu- 
larly rich  in  nitrogenous,  starchy  and  phosphorated  principles.  They 
contain,  at  least,  20  per  cent  of  proteins.  But,  after  all,  for  the  great 
mass  of  the  people  of  India — in  fact,  for  the  vast  majority  of  the  inhabi- 
tants of  tropical  Asia — rice  is  the  staple  food.  There  are  two  principal 
varieties,  Burma  and  country  rice.  Burma  rice,  being  highly  milled,  has 
the  husk,  pericarp  and  outer  layer  removed  by  machinery,  stripping  it  of 
its  protein,  phosphorus  and  vitamines.     Country  rice  is  soaked  in  water 


DIET    IN    TROPICAL    CLIMATES 


391 


TABLE  L— PROTEIN  AND  STARCH  EQUIVALENTS  IN  CEREALS  AND 

BUCKWHEATS  (Church)  ' 
(The  figures  represent  ounces  and  decimals  of  an  ounce) 


1  oz. 

2oz. 

3  oz. 

4  oz. 

5  oz. 

6  oz. 

7  oz. 

8oz. 

9oz. 

Ragi: 

Protein 

.059 
.764 

.07 

.82 

.073 
.797 

.084 
.794 

.091 
.773 

.095 
,790 

.093 
.769 

.096 
.757 

.104 
.791 

.108 
.801 

.115 
.730 

.126 

.777 

.143 
.760 

.135 
.712 

.152 
.714 

.192 

.578 

.118 
1.528 

.14 
1.64 

.146 
1.594 

.168 
1.588 

.182 
1.546 

.190 
1.580 

.186 
1.538 

.192 
1.514 

.208 
1.582 

.216 
1.602 

.230 
1.460 

.252 
1.554 

.286 
1.520 

.270 
1.424 

.304 
1.428 

.384 
1.156 

.177 
2.292 

.21 
2.46 

.219 
2.391 

.252 
2.382 

.273 
2.319 

.285 
2.370 

.279 
2.307 

.288 
2.271 

.312 
2.373 

.324 
2.403 

.345 
2.190 

.378 
2.221 

.429 
2.280 

.405 
2.136 

.456 
2.142 

.576 
1.734 

.236 
3.056 

.28 
3.28 

.292 

3.188 

.336 
3.176 

.364 
3.092 

.380 
3.160 

.372 
3.076 

.384 
3.028 

.416 
3.164 

.432 
3.204 

.460 
2.920 

.504 
3.108 

.572 
3.040 

.540 

2.848 

.608 
2.856 

.768 
2.312 

.295 
3.820 

.35 
4.10 

.365 
3.985 

.420 
3.970 

.455 
3.865 

.475 
3.950 

.465 
3.845 

.480 
3.785 

.520 
3.955 

.540 
4.005 

.575 
3.650 

.630 
3.885 

.715 
3.800 

.675 
3.560 

.760 
3.570 

.960 
2.890 

.354 

4.584 

.42 
4.92 

.438 

4.782 

.504 
4.764 

.546 
4.638 

.570 
4.740 

.558 
4.614 

.576 
4.542 

.624 
4.746 

.648 
4.806 

.690 
4.380 

.756 
4.662 

.858 
4.560 

.810 
4.272 

.912 

4.284 

1.152 
3.468 

.413 
4.348 

.49 
5.74 

.511 
5.579 

.588 
5.558 

.637 
5.411 

.665 
5.430 

.651 
5.383 

.672 
5.299 

.728 
5.537 

.756 
5.607 

.805 
5.110 

.882 
5.439 

1.001 
5.320 

.945 
4.984 

1.064 
4.998 

1.344 
4.046 

.472 
6.112 

.56 
6.56 

.584 
6.376 

.672 
6.352 

.728 
6.184 

.760 
6.320 

.744 
6.152 

.768 
6.056 

.832 
6.328 

.864 
6.408 

.920 
5.840 

1.008 
6.216 

1.144 
6.080 

1.080 
5.696 

1.216 
5.712 

1.536 
4.624 

.531 

Starch 

6.876 

Koda: 

Protein 

.63 

Starch 

7.38 

Rice: 

Protein 

.657 

Starch 

7.173 

Sanwa: 
Protein 

.756 

Starch 

7.146 

Gundi: 

Protein 

.819 

Starch 

6.957 

Maize: 
Protein 

.885 

Starch 

7.110 

Joar: 

Protein 

.837 

Starch 

6.921 

Shama: 

Protein 

.864 

Starch 

6.813 

Bajra: 

Protein 

.936 

Starch 

7.119 

Kangni : 

Protein 

.972 

Starch 

7.209 

Barley: 

Protein 

1.035 

Starch 

6.570 

Chena: 

Protein 

1.134 

Starch 

6.993 

Amaranth: 

Protein 

1.287 

Starch 

6.840 

Wheat: 

Protein 

1.215 

Starch 

6.408 

Buckwheat: 

Protein 

1.368 

Starch 

6.426 

Quinoa: 

Protein 

Starch.. . 

1.728 
5.202 

1  Sini])son  in  "Tropical  Hygiene." 


392 


DIET    IN   HEALTH 


TABLE  XL— PROTEIN  AND  STARCH  EQUIVALENTS  IN  PULSE  (Church) 
(The  figures  represent  ounces  and  decimals  of  an  ounce) 


1  oz. 


2oz. 


3oz. 


4  oz. 


5  oz. 


6  oz. 


7  oz. 


Soy  Beans: 

Protein. 

Starch 

Vetchlings : 

Protein 

Starch 

Lupines: 

Protein 

Starch 

Vetches: 

Protein 

Starch 

Guar: 

Protein 

Starch 

Lentils: 

Protein 

Starch 

Peanuts : 

Protein 

Starch 

Moth: 

Protein 

Starch 

Peas: 

Protein 

Starch 

Catiang-beans: 

Protein 

Starch 

Haricots: 

Protein 

Starch 

Mung-beans: 

Protein 

Starch 

Horsegram : 

Protein 

Starch 

Lablab-beans: 

Protein 

Starch 

Pigeon-peas: 

Protein 

Starch 

Chick-peas: 

Protein 

Starch 

Inga-beans: 

Protein 

Starch 

1  Simpson  in 


.353 
.694 

.319 
.521 

.317 
.452 

.315 
.497 

.298 
.494 

.249 
.595 

.245 
1.267 

.238 
.580 

.236 
.575 

.231 

.578 

.230 
.576 

.227 
.608 

.225 
.603 

.224 
.574 

.203 
.596 

.195 
.643 

.176 

.807 


.706 
1.388 

.638 
1.042 

.634 
.904 

.630 
.994 

.596 
.988 

.498 
1.190 

.490 
2.534 

.476 
1.160 

.472 
1.150 

.462 
1.156 

.460 
1.152 

.454 
1.216 

.450 
1.206 

.448 
1.148 

.406 
1.192 

.390 
1.286 

.352 
1.614 


1.059 
2.082 

.957 
1.563 

.951 
1.356 

.945 
1.491 

.894 
1.482 

.747 
1.785 

.735 
3.801 

.714 
1.740 

.708 
1.725 

.693 
1.734 

.690 
1.728 

.681 
1.824 

.675 
1.809 

.672 
1.722 

.609 

1.788 

.585 
1.929 

.528 
2.421 


1.412 
2.776 

1.276 
2.084 

1.268 
1.808 

1.260 
1.988 

1.192 
1.976 

.996 
2.380 

.980 
5.068 

.952 
2.320 

.944 
2.300 

.924 
2.312 

.920 
2.304 

.908 
2.432 

.900 
2.412 

.896 
2.296 

.812 
2.384 

.780. 
2.572 

.704 
3.228 


1.765 
3.470 

1.595 
2.605 

1.585 
2.260 

1.575 
2.485 

1.490 
2.470 

1.245 
2.975 

1.225 
6.335 

1.190 
2.900 

1.180 
2.875 

1.155 
2.890 

1.150 

2.880 

1.135 
3.040 

1.125 
3.015 

1.120 
2.870 

1.015 
2.980 

.975 
3.215 

.880 
4.035 


2.118 
4.164 

1.914 
3.126 

1.902 
2.712 

1.890 

2.982 

1.788 
2.964 

1,494 
3.570 

1.470 
7.602 

1.428 
3.480 

1.416 
3.450 

1.386 
3.468 

1.380 
3.456 

1.362 
3.648 

1.350 
3.618 

1.344 
3.444 

1.218 
3.376 

1.170 

3.858 

1.056 

4.842 


2.471 

4.858 

2.233 
3.647 

2.219 
3.164 

2.205 
3.479 

2.086 
3.458 

1.743 
4.165 

1.715 
8.869 

1.666 
4.060 

1.652 
4.025 

1.617 
4.046 

1.610 
4.032 

1.587 
4.276 

1.575 
4.221 

1.568 
4.018 

1.421 
4.172 

1.365 
4.501 

1.232 
5.649 


Tropical  Hygiene. 


DIET    TX    TROPICAL    CLIMATES 


393 


for  at  least  a  day  and  night,  and  then  strained  and  dried  in  the  sun,  after 
which  the  husk  is  roughly  removed.  It  therefore  retains  most  of  its  peri- 
carp and  outer  layers,  which  contain  protein,  phosphates  and  vitamines. 
liice  is  the  poorest  of  the  cereals  in  protein  and  mineral  matter.  On  the 
other  hand,  it  has  the  advantage  of  occurring  in  small  and  easily  digested 
gi'ains.  Boiled  rice  swells  and  absorbs  nearly  five  times  its  weight  of 
water,  while  some  of  its  mineral  constituents  are  lost  by  solution.  Rice, 
being  Itirgely  starch,  is  only  in  very  small  part  digested  in  the  stomach, 
but  Lukis  and  Blackham  state  that  its  solid  constituents,  being  quite  com- 
pletely digested  in  the  small  intestine,  enter  the  blood  almost  as  completely 
as  those  of  meat-^two  and  one-half  ounces  cooked  by  boiling  requiring 
three  and  a  half  hours  for  disposal.  Practically  none  of  the  starch  is 
lost,  whereas  the  waste  of  protein  foods  amounts  to  about  19  per  cent. 
It  follows  from  this  that  rice  is  one  of  the  foods  which  leaves  the  smallest 
residue  in  the  intestine,  a  property  which  gives  it  a  considerable  value  in 
some  cases  of  disease. 

As  Simpson  points  out,  in  the  construction  of  European  standard  diets 
the  basis  has  generally  been  a  person  weighing  154  pounds  and  doing  a 
day's  work  of  300  foot-tons,  or  about  2  foot-tons  per  pound  of  body- 
weight.  In  Indian  and  Japanese  dietary  tables  the  lesser  body-weight 
of  105  pounds  has  usuall}'  formed  the  basis,  the  2  foot-tons  of  work  being 
retained. 

Church  gives  the  following  standard  diets  for  Indians  weighing  105 
pounds,  expressed  in  avoirdupois  ounces  and  decimals  of  an  ounce: 


CHURCH'S  STANDARD  DIET  FOR  INDIANS 


R.\TION 

Protein 

Oil 

Starch 

Starch 
equivalent 

Nutrient 
ratio 

Bare  su.stenance 

2.1 

2.954 

3.635 

0.752 
1.412 
2.506 

7.520 
12.531 
11.190 

9.250 
15.779 
16.954 

1 :4.34 

Moderate  work 

1 :5.34 

Hard  work 

1 :4.66 

Lukis  an<l  Blackham  give  the  following  as  the  scale  in  a  Bengal  jail: 

Burma  or  country  rice 20  ounces 

Different  dais 6       « 

Vegetables 6       " 

Flour,  Wheat  or  Indian  Corn 10  or  12  ounces 

These  amounts  represent  only  what  is  absolutely  essential.     Perhaps 
a  better  standard  is  furnished  by  the  war  ration  of  the  Indian  sepoy, 


394  DIET    IX    HEALTH 

^vhich  generally  consists  of  atta  or  rice,  2  pounds,  or  sometimes  meat  or 
fish,  2  pounds;  ghee,  2  ounces;  dal,  4  ounces;  salt,  %  ounce;  also  meat 
and  condiments  on  payment.  In  some  expeditions  onions  and  dried  man- 
goes have  been  issued.  The  following  ration  has  been  suggested  for  Aden 
camel  drivers:  Biscuit  or  rice,  ly^*  pounds;  dates,  wet,  1  jwund ;  ghee,  2 
ounces ;  sugar,  2  ounces ;  coffee,  '^  ounce ;  salt,  ^  ounce ;  onions,  2  ounces, 
or  dal,  %  ounce. 

Church,  quoted  by  Simpson,  gives  several  examples  of  rations,  viz. : 
A  dietary  for  moderate  work,  according  to  this  author,  calls  for  2.1)54  oz. 
protein,  1.412  oz.  oil,  and  12.531  oz.  starch,  the  starch  equivalent  of  which 
is  15.779.  Soy  beans,  5  oz.,  furnish  protein  1.765,  starch  3.470.  Rice,  16 
oz.,  furnishes  protein  1.163,  starch  12.752.  Total  protein  2.928.  Total 
starch  16.222.  As  the  oil,  however,  in  this  ration  is  but  1  oz.  and  should 
be  1.4  oz.,  it  will  be  necessary  to  add  the  lacking  four-tenths.  To  do  this 
without  disturbing  the  ration,  IVo  oz.  of  rice  should  be  withdrawn,  and 
I/O  oz.  of  soy  beans  added.  Then  the  amounts  will  be,  soy  beans,  5^/2 
oz.,  furnish  protein,  1.942,  starch  3.817.  Rice,  14^2  oz.,  furnishes  pro- 
tein .954,  starch  11.552,  oil  .4  oz.,  the  oil  being  equal  to  starch  .920.  This 
ration  has,  therefore,  2.896  oz.  protein  and  the  equivalent  of  16.289 
starch. 

Church  lays  down  two  guiding  principles,  one  is  to  keep  down  the 
legume  constituent  to  an  amount  not  exceeding  7  ounces  per  diem,  and 
if  possible  not  more  than  5  ounces  per  diem ;  the  other  is  to  ensure  the 
presence  of  a  sufficiency  of  protein  (or  albuminoids,  as  he  calls  them)  by 
increasing  the  cereal  constituents  of  the  ration,  even  if  in  so  doing  the 
quantity  of  starch  required  be  raised  above  the  necessary  amount. 

Milk. — Manson(29),  referring  to  the  milk  supply  in  tropical  coun- 
tries, says,  in  part,  "that  in  many  tropical  countries,  such  as  West  Africa, 
milk  cannot  be  obtained  except  in  preserved  form.  In  other  countries,  as 
India,  cow's,  goat's  or  buffalo's  milk  can  be  readily  procured.  Buffalo's 
milk  is  very  rich  in  fat,  there  being  nearly  twice  as  much  as  in  cow's 
milk.  It  is  also  richer  in  proteins,  though  not  so  rich  in  lactose.  It  is 
less  digestible,  has  a  peculiar  smell  and  flavor,  and,  as  a  rule,  is  not  suited 
for  invalids.  Goat's  milk  differs  less  from  cow's  milk;  but  as  the  goat  is 
susceptible  to  !Malta  fever,  and  the  Mirrococnis  mpHtmsin  is  discharged 
in  the  milk  of  infected  animals,  it  is  l)etter  not  to  use  the  milk  unless 
efficiently  pasteurized  or  well  boiled."  The  Board  of  Agriculture  and 
Fisheries  of  Great  Britain  published,  in  the  early  part  of  February,  1916, 
a  circular  relating  to  goat's  milk,  in  which  it  was  stated  that  it  is,  as  a 
rule,  a  most  wholesome  milk,  and  that  its  flavor,  if  the  food  of  the  animal 


DIET    I:N^    TKOPICAL    climates  395 

is  regulated,  is  not  any  real  drawback  to  its  employment.  Moreover,  goat's 
milk  is  easily  digested  by  children,  and  is  far  less  likely  than  cow's  milk 
to  contain  tubercle  bacilli.  The  composition  of  cow's  milk  and  goat's  milk 
is  much  the  same,  although  goat's  milk  is  superior  as  regards  fat,  which  is 
an  advantage. 

^Vllere  cow's  milk  is  available  it  should  be  used  in  preference  to  pre- 
served milk.  In  the  tropics,  as  stated  previously,  unless  milk  can  be  con- 
sumed fresh  from  the  cow,  it  must  be  boiled,  or  efficiently  pasteurized, 
and  thus  rendered  slightly  less  digestible  and  deprived  of  certain  of  its 
nutritive  properties.  Manson  states  that  it  is  necessary  to  boil  milk  in 
the  tropics,  ''because  (a)  under  tropical  conditions,  the  multiplication  of 
bacteria  is  so  rapid  that  milk  quickly  turns  sour;  (&)  the  natives  fre- 
quently add  water  to  the  milk  and  are  apt  to  be  careless  as  regards  the 
washing  and  scalding  of  the  utensils  used;  (c)  the  water  used  for  such 
dilution  and  for  washing  utensils  is  usually  drawn  from  shallow  pools  or 
wells  liable  to  contamination,  especially  as  inspection  and  regulation  of  the 
milk  supplies  in  the  tropics  are  very  lax;  (d)  obvious  impurities  are 
strained  off  with  old  rags  or  articles  of  clothing  actually  in  use;  (c) 
cattle  are  often  fed  on  garbage  of  all  kinds." 

The  alternative  to  boiling  milk,  when  it  is  intended  for  consumption 
by  Europeans,  or  for  use  in  hospitals,  is  to  keep  the  cows  under  the  best 
sanitary  conditions  possible  and  to  be  sure  that  they  are  milked  under 
strict  sanitary  precautions.  It  is  patent  that  the  difficulties  in  the  way 
of  insuring  a  comparatively  pure  milk  are  so  great  in  tropical  countries 
as  to  be  nearly  insuperable.  Moreover,  in  many  districts  fresh  milk  is  not 
available.  It  therefore  follows  that  canned  milk  is  largely  used.  Manson 
is  of  the  opinion  that  the  sweetened  milks  should  be  avoided  for  the  use  of 
invalids,  and  thinks  that  the  best  tinned  milks  are  those  in  which  the  milk 
is  not  reduced  to  a  paste  but  merely  concentrated  and  is  still  in  fluid  form. 
The  can  must  be  carefully  examined  to  see  that  there  has  been  no  previous 
puncture  or  bulging,  and  the  milk  must  be  odorless.  A  can  once  opened 
must  be  used  quickly. 

Meats. — Simpson,  unlike  Lukis  and  Blackham,  is  inclined  to  agree 
with  the  views  of  Chittenden  that  most  people  eat  more  protein  food  than 
is  recjuisite  to  preserve  health  and  maintain  energy.  But  it  must  be  taken 
into  consideration  that,  since  Simpson  wrote  his  work  on  diet  in  the 
tropics,  the  investigations  of  other  workers  appear  to  have  demonstrated 
with  greater  or  less  certainty  that  Chittenden's  views  are  not  altogether 
borne  out  by  facts,  and  are  in  some  degree  misleading.  Simpson  draws 
from  a  study  of  Chittenden's  experiments  the  conclusion  that  not  only 


39G  DIET    m   HEALTH 

does  the  European  standard  of  diet  err  in  the  direction  of  allowing  too 
great  an  amount  of  proteins,  but  argues  that  greater  efficiency  in  working 
power,  and  a  better  feeling  of  well  being  and  health  are  attained  by  a 
smaller  amount  of  proteins  than  with  the  excessive  amounts  taken  in  ordi- 
nary diets,  which,  as  a  rule,  contain  even  more  than  outlined  in  the 
standard  diets.  He  thinks  that  the  evidence  put  forward  in  favor  of  these 
views  is  strong,  and.  is  supported  by  the  fact  that  nations  such  as  the 
Japanese  or  Indians,  living  a  simpler  life,  and  more  given  to  vegetarianism 
than  the  Europeans  or  Americans,  are  maintained  in  health  on  a  much 
smaller  amount  of  protein  food  than  these  standards  indicate  is  necessary. 
According  to  Simpson,  although  man  requires  a  mixed  diet,  with  some 
reservations  relating  to  custom  and  climate,  it  is  a  matter  of  indifference 
whether  the  mixed  diet  is  obtained  wholly  from  vegetable  products,  or 
partly  from  animal  and  partly  from  vegetable  products,  and  it  is  further 
his  opinion  that  whether  grains  or  meat  shall  enter  most  largely  into  the 
diet  depends  a  great  deal  on  climate,  on  the  habits  of  the  people,  whether 
indolent  or  active,  and  on  other  circumstances. 

However,  although  this  authority  seems  to  favor  a  vegetarian  diet  for 
natives  and  a  diet  for  white  men  in  the  tropics  in  which  the  carbohydrates 
preponderate,  the  force  of  his  argument  is  somewhat  lessened,  so  far  as  the 
natives  are  concerned,  by  the  following  statement  made  by  him.  The 
inhabitants  of  hot  climates  are  generally  content  with  milk  products, 
legumes,  fruits  and  sugars,  but  though  cereal  grains,  as  a  rule,  form  the 
chief  food  of  such  people,  rice  being  the  staple  wherever  there  is  plenty 
of  water  and  rain,  still  there  are  considerable  numbers  whose  food  is 
largely  from  the  animal  kingdom.  Thus,  the  Arabs  of  East  Africa,  the 
Pampas  Indians,  and  the  Abyssinians  are  often  quoted  as  instances  of 
consumers  of  large  quantities  of  meat.  They  are  all  very  active  races. 
Indeed,  as  pointed  out  before,  the  mass  of  the  inhabitants  of  India  who 
exist  mainly  on  rice  and  some  other  cereals  are,  generally  speaking,  miser- 
able specimens  of  humanity,  exceedingly  prone  to  infection,  and  so  de- 
ficient in  vitality  that  when  attacked  by  disease  they  die  like  flies.  The 
vigorous  races  of  India  are  those  who  eat  flesh,  not  to  excess,  but  still  suf- 
ficient in  amount  to  supply  the  protein  needs  of  the  organism.  It  is  also 
worthy  of  notice  that  the  Japanese,  who  of  all  the  Asiatic  peoples  are 
especially  capable,  physically  and  mentally,  do  not,  by  any  means,  restrict 
themselves  to  a  vegetarian  diet.  It  is  true,  though,  that  at  one  time  the 
Japanese  might  have  been  termed  a  vegetarian  people,  but  this  was  more 
from  necessity  than  choice,  and  they  have  always  been  great  fish  eaters. 
During  the  Russo-Japanese  war,  when  the  Japanese  soldiers  were  justlj^ 


DIET    lx\    TEOPICAL    CLIMATES  397 

lauded  for  their  remarkable  powers  of  endurance,  their  capabilities  in  this 
direction  were  attributed  to  their  being  vegetarians.  When,  however,  the 
matter  was  more  closely  investigated,  it  was  found  that  the  Japanese 
rfoldiers'  rations  comprised  a  certain  amount  of  meat. 

A  point,  too,  to  which  attention  is  not  sufficiently  paid,  is  that  while 
diet  must  be  modified  to  some  extent  to  adapt  it  to  the  physiological  re- 
quirements of  varying  climates,  to  insist  that  a  white  man  in  the  tropics 
must  eat  the  same  food  as  the  native  is  carrying  this  principle  to  absurd 
lengths.  Evidence,  and  recent  evidence  in  particular,  would  seem  to  go 
to  show  that  even  the  native  who  has  been  so  long  accustomed  to  a  carbo- 
hydrate diet  that  it  has  become  a  fixed  habit,  is  all  the  better  for  some  meat. 
Simpson  takes  the  stand  that  the  most  probable  defect  in  the  diet  of  a 
European  in  the  tropics  is  that  it  is  too  nitrogenous  and  fatty,  and  illus- 
trates this  contention  by  an  instance  drawn  from  history  or  tradition. 
When  the  Aryans  first  descended  into  the  plains  of  India  they  were  meat 
eaters,  but  the  experience  of  the  centuries  evidently  taught  them  to  be 
vegetarians,  or  to  be  very  sparing  in  the  amount  of  meat  they  ate,  and  at 
the  same  time  to  become  total  abstainers.  This,  says  Simpson,  is  an  expe- 
rience and  a  lesson  which  Europeans  who  go  to  the  tropics  are  inclined  to 
ignore.  Accustomed  to  living  well  in  their  own  country,  on  large  quanti- 
ties of  meat,  fats  and  rich  foods,  to  which  wines  and  spirits  are  added 
in  considerable  quantities,  they  are  tempted  to  follow,  as  closely  as  possible, 
a  similar  diet  in  the  tropics.  This  procedure  is  generally  followed  by 
injurious  results  due  to  want  of  adjustment  of  the  diet  to  the  new  con- 
ditions, and  is  often  disastrous  to  the  health,  as  attested  by  the  history  of 
the  British  occupation  of  India.  Within  recent  years  an  adjustment  has 
taken  place,  and  the  health  and  mortality  of  Europeans  have  undergone 
a  great  change  for  the  better.  Emphasis  may  again  be  laid  on  the  point 
that  the  present  inhabitants  of  India  eat  mainly  carbohydrate  food  simply 
from  economical  reasons  or  because  their  religion  forbids  them  to  consume 
meat,  and,  as  stated  before,  those  of  the  natives  who  eat  meat  in  India  are 
greatly  superior  in  physique  and  in  powers  of  endurance  to  the  vege- 
tarians. 

With  regard  to  the  too  indulgent  habits  of  the  white  men  who  come 
to  the  tropics,  it  is  no  doubt  true  that  they  eat  and  drink  more  than  is 
good  for  them,  though  this  was  more  frequently  the  case  in  former  times 
than  at  the  present.  But  as  Sir  Patrick  Manson(29),  who  is  probably 
the  greatest  living  authority  on  such  matters,  says,  the  effects  of  dietetic 
errors  in  Europeans  in  the  tropics  are,  on  the  whole,  more  marked  than 
would  be  the  case  from  similar  errors  in  temperate  climates.     This  is 


398  DIET    IN    HEALTH 

especially  so  as  regards  the  abuse  of  alcohol  and  condiments,  and  also  as 
regards  the  deficiency  of  fresh  vegetables,  of  fruits  and  occasionally  of 
meat.  Mauson  has  at  once  placed  his  finger  on  the  dietetic  error  of  the 
European  in  the  tropics  which  most  tends  to  injure  his  digestive  organs, 
upset  his  nervous  system,  impair  his  health  generally,  and  sap  his  vital 
forces.  This  is  the  too  great  consumption  of  alcohol  and  condiments.  It 
must  be  borne  in  mind  that  the  meat  one  gets  in  the  tropics  is  not  like  the 
meat  of  temperate  climes.  The  animals  there  are  not  well  fed,  and  their 
meat  is  usually  stringy,  tough  and  of  an  insipid  flavor.  Th^  consequence 
is  that  more  thorough  cooking  is  resorted  to.  This  in  itself  destroys  or  les- 
sens the  already  somewhat  meager  nutritive  properties  of  the  meat,  and,  in 
addition,  to  give  some  zest  to  the  food  the  dishes  are  frequently  highly 
spiced  and  a  larger  variety  of  methods  of  preparation  are  employed.  The 
result  is  that,  while  the  bulk  of  the  food  taken  is  as  much  or  even  more 
than  in  Europe,  the  good  effects  of  the  protein  material  are  greatly  de- 
creased by  its  being  taken  in  indigestible  forms.  In  fact,  food  so  cooked 
and  spiced  often  does  more  harm  than  good.  Again,  the  fruits  are  some- 
times comparatively  dry  and  tasteless,  as  is  apt  to  be  the  case  in  all  tropical 
climates  where  they  mature  quickly,  and  the  vegetables  are  liable  to  be 
indigestible  and  of  inferior  quality. 

It  must,  then,  be  taken  into  consideration  that  in  the  tropics  neither 
meat  nor  foods  from  the  vegetable  kingdom  are  of  the  same  high  standard 
as  in  temperate  climes.  When  injudicious  cooking  and  the  too  liberal  use 
of  condiments  are  added  to  these  drawbacks,  it  may  be  well  understood 
why  digestive  disorders  prevail.  Nevertheless,  with  all  dietetic  and  culi- 
nary obstacles  with  which  the  white  man  has  to  contend,  the  fact  stands 
out  clearly  that  he  possesses  a  resisting  power  to  infection  and  disease 
which  is  absent  from  the  native.  Moreover,  it  may  be  once  again 
insisted  upon  that  the  meat-eating  native  has  a  superior  vitality  to  the 
vegetarian  inhabitant  of  tropical  Asia,  which  goes  to  show  that  the  ma- 
jority of  the  indigenous  population  of  the  tropics  do  not  eat  enough  pro- 
tein material. 

Sweets. — A  very  interesting  and  instructive  feature  in  connection  with 
diet  in  the  tropics  is  that  Europeans  born  and  bred  in  tropical  lands  have 
less  desire  for  meat  and  a  special  predeliction,  sometimes  amounting  to  a 
craving,  for  sugar.  Inhabitants  of  the  Far  East  and  the  dwellers  in  hot 
climates  generally  exhibit  an  excessive  desire  for  sweet  things.  When 
presents  are  made  in  Asia,  they  usually  take  the  form  of  sweetments,  and 
the  ladies  of  the  harem  are  depicted,  as  a  rule,  lolling  on  couches  and  for- 
ever eating  sweets.     No  doubt  this  craving  has  a  physiological  basis. 


DIET    IN    TKOPICAL    CLIMATES  399 

Sweets  take  the  place  to  some  extent  of  proteiu  material,  or  rather  are 
protein  sparers,  being  rapidly  oxidized.  In  the  Boer  war  the  British 
soldiers  were  supplied  with  a  daily  ration  of  chocolate,  for  it  is  known 
to  liberate  energy  rapidly  with  the  least  possible  strain  upon  the  digestive 
system.  Sugar,,  an  almost  pure  soluble  carbohydrate,  is  perhaps  the  best 
food  for  this  purpose.  Mosso  first  demonstrated  that  sugar  lessened 
fatigue,  while  Vaughan  Harley  showed  that  it  was  an  excellent  spur  to 
energy  with  which  extraordinary  muscular  exertion  could  be  made. 

Simpson  mentions  that  among  the  troops  engaged  in  Porto  Rico  and 
in  the  Philippines  whose  appetites  had  become  impaired,  there  was  a 
craving  for  candy  and  sweets  which  was  relieved  by  a  supply  of  these 
articles.  Numerous  experiments  have  demonstrated  that  fatigue"  is  more 
quickly  relieved  by  sugar  than  by  any  other  kind  of  food,  and  in  the 
tropics,  where  exhaustion,  by  reason  of  the  heat  and  the  actinic  rays  of  the 
sun,  is  most  likely  to  occur,  the  value  of  sugar  can  scarcely  be  over- 
estimated. 

Diet  and  Disease. — When  writing  or  speaking  of  diet  in  the  tropics  one 
must  be  careful  to  avoid  the  faults  of  exaggeration.  To  assert  that  a  white 
man  should  eat  as  much  meat  or  more  than  in  a  temperate  climate  would 
be,  perhaps,  to  sin  in  this  direction.  On  the  other  hand,  to  aver  that  a 
strictly  carbohydrate  diet  was  the  one  most  suitable  for  the  white  dweller 
in  a  hot  climate  would  be  to  err  even  more  grossly.  Although  white  men 
have  dwelt  in  the  tropics  for  generations,  scientific  men  still  agree  to 
differ  as  to  the  form  of  diet  best  adapted  to  the  climate.  Recent  investi- 
gations appear  to  prove  that  a  mixed  or  modified  diet  is  not  only  the  best 
for  white  men  but  for  the  natives  themselves.  It  is  absolutely  certain  that 
rice,  and  especially  milled  rice,  the  form  of  food  most  largely  eaten  by  the 
natives,  is  deficient  in  nitrogenous  matter  and  over  bulky  in  carbonaceous 
matter.  The  best  rice  is  also  deficient  in  phosphoric  acid,  lime  and  other 
mineral  matters.  As  a  matter  of  fact,  the  diet  of  the  natives  is  responsi- 
ble for  lowered  vitality  and  is  directly  responsible,  according  to  many 
authorities,  for  beriberi. 

Accordingly,  diet  may  be  a  direct  cause  of  disease.  Excess  of  protein 
material  in  the  diet  of  the  European,  and  deficiency  of  proteins  in  that 
of  the  poorer  classes  of  natives,  and  in  some  institutions,  are  instances 
of  this. 

In  the  prevention  of  disease,  it  goes  without  saying  that  diet  plays  a 
role  of  the  utmost  importance.  Putting  on  one  side  the  chronic  diseases 
which  are  likely  to  occur  in  the  tropics  from  errors  of  diet  more  quickly 
than  in  colder  lands,  it  must  be  remembered  that  food  contamination  is 


400  DIET    IN    HEALTH 

rife  iu  hot  climates.  Flies  in  such  countries  are  indeed  a  veritable  plagiie, 
and  if  extreme  care  be  not  taken  to  protect  food,  epidemics  will  be  spread 
far  and  wide.  Human  excreta  are  less  thoroughly  dealt  with  and  provide 
a  remarkably  favorable  means  by  which  flies  may  convey  disease.  Cholera, 
as  well  as  typhoid  fever,  has  been  shown  to  be  carried  in  this  manner, 
and  flies  are  under  suspicion  of  being  concerned  in  the  dissemination  of 
other  diseases. 

Canned  Foods. — Before  leaving  the  subject  of  diet  in  the  tropics,  it 
may  not  be  out  of  place  to  consider  briefly  the  question  of  canned  foods. 
In  the  torrid  lands,  for  obvious  reasons,  canned  foods  are  largely  con- 
sumed. Of  course,  they  are  more  frequently  used  than  they  should  be, 
for  their  nutritive  value  is  less  than  that  of  fresh  meat  and  their  consump- 
tion is  open  to  several  other  objections.  There  is  a  certain  amount  of  risk 
of  metallic  poisoning,  but  the  gravest  charge  that  can  be  brought  against 
the  indiscriminate  use  of  canned  meat  is  that  it  is  always  difficult  to  deter- 
mine how  long  the  food  has  been  tinned.  The  temptation  to  send  abroad 
tins  already  old  is  too  great  for  some  unscrupulous  dealers.  In  any  event, 
tins  of  meat  which  have  been  kept  for  a  considerable  period  are  retailed 
in  all  parts  of  the  tropics  with  the  result  that  serious  digestive  disorders 
are  frequent,  and  even  ptomaine  poisoning  is  by  no  means  rare. 

Conclusions. — In  the  light  of  the  most  recent  researches,  it  would  seem 
to  have  been  demonstrated  that  a  goodly  amount  of  protein  material  should 
be  eaten  by  the  white  dwellers  in  the  tropics,  and  that  it  is  not  in  the 
interests  of  health  that  the  protein  part  of  the  diet  should  be  unduly  de- 
creased. It  would  be  manifestly  unwise  for  the  white  man  to  endeavor  to 
subsist  on  the  form  of  food  eaten  by  the  native.  A  modified  diet  is  best 
suited  to  the  bodily  and  mental  requirements  of  the  white  man  in  the 
tropics,  but  as  in  temperate  climates  he  must  be  largely  guided  by  his 
mode  of  life.  Such  a  diet  should  not  contain  so  much  protein  matter  as 
in  colder  climates,  but  the  carbohydrates  and  proteins  should  be  judiciously 
distributed  in  proportion  to  the  individual's  needs.  In  the  case  of  white 
men,  at  any  rate,  most  of  the  protein  material  should  be  supplied  by  meat. 
Meat  should  not  be  cooked  too  long  nor  should  condiments  be  added  to  any 
great  extent.  Great  care  should  be  exercised  in  protecting  foodstuffs,  and 
especially  meat  and  milk,  from  contamination  or  infection,  and  milk  and 
meat  should  be  consumed  as  fresh  as  is  possible.  Moderation  in  eating 
should  be  the  slogan  of  the  white  man  in  the  tropics,  and  if  the  above  rules 
are  carefully  observed,  there  is  no  reason,  at  least  so  far  as  diet  is  con- 
cerned, why  he  should  not  enjoy  good  health.  It  must  be  remembered, 
however,  that  he  must  accommodate  his  diet,  to  a  certain  extent,  to  the 


ALCOHOL  AND  liEVEKAGLS  li\   THE  TKOriCS       401 

variations  of  climate,  which  are  more  frequent  in  tropical  than  in  tem- 
perate zones. 

Into  the  question  of  the  diet  of  the  natives,  it  is  superfluous  to  enter 
at  length.  Suffice  it  to  reiterate  that  investigations  seem  to  show  that  those 
who  eat  meat  are  more  vigorous  than  those  who  are  vegetarians.  It  will 
be  observed  that  in  this  section  the  diet  of  India  has  been  mainly  discussed. 
This  is  because  more  is  accurately  known,  of  the  diet  question  in  India 
than  in  other  tropical  parts  of  the  world.  Still  it  is  known  that,  in  Africa 
and  in  other  tropical  climates,  those  natives  who  eat  meat  are  stronger 
than  those  who  subsist  solely  on  vegetable  foods.  The  subject  has  been 
treated  in  a  broad  way  and  only  general  principles  have  been  laid  down, 
and  while  the  authors  are  conscious  that  the  matter  has  been  dealt  with 
somewhat  discursively,  it  is  hoped  that  the  information  given  may  prove 
of  some  practical  value. 

ALCOHOL  AND  BEVERAGES  IN  THE  TROPICS 

The  question  of  alcohol  as  a  beverage  or  as  a  medicine  is  a  vexed  one 
among  scientific  and  medical  men,  and  has  been  the  cause  of  a  good  deal 
of  acrimonious  discussion.  There  are  those  who,  like  Sir  Victor  Horsley, 
hold  that  it  is  a  poison  in  any  circumstance,  and  contend  that  its  value  as 
a  medicinal  remedy  is  nil.  Again  there  are  those  like  Karl  Pearson,  At- 
water  and  others,  who  deny  that  alcohol  is  absolutely  useless,  and  argue  that 
it  has  a  food  value  and  that,  when  taken  in  discretion,  it  by  no  means 
always  does  harm,  and  may,  on  occasions,  do  good.  Pearson  appears  to 
have  proved  that  the  sins  of  the  fathers  are  not  visited  on  the  children,  that 
is,  so  far  as  the  hereditary  influence  of  alcohol  is  concerned.  He  made  a 
series  of  careful  investigations  and  seems  to  have  demonstrated  that  the 
children  of  habitual  drinkers  differ  but  little,  if  at  all,  from  those  of  the 
abstainer  or  from  the  ordinary  moderate  drinking  individual.  However, 
this  assertion  and  the  investigations  upon  which  it  was  based  were  severely 
criticised  by  Horsley  and  his  followers,  and  it  docs  appear  probable  that 
the  ofi"spring  of  drunkards  exhibit  certain  inherited  physical  and  mental 
characteristics  of  an  abnormal  nature.  They  have  handed  down  to  them, 
as  a  rule,  a  somewhat  unstable  nervous  system,  which  renders  them  more 
prone  to  the  effects  of  stimulating  drinks  than  their  fellows  who  have  not 
had  as  their  progenitors  those  addicted  to  the  excessive  use  of  alcohol. 
However,  alcohol  and  its  effects  have  been  exhaustively  discussed  from  the 
scientific  standpoint  in  the  chapter  on  "Stimulants,"  and,  as  recapitulation 
is  a  weariness  of  the  flesh,  we  will  refrain  from  offending  our  readers  in 
this  respect. 


402  DIET    IN    HEALTH 

The  subject  of  the  use  of  alcohol  in  the  tropics  will  be  gone  over 
briefly,  and  its  pros  and  cons  considered  impartially.  For  some  time  now, 
it  has  been  taught  by  the  majority  of  medical  men  who  have  had  such  a 
varied  and  lengthy  experience  of  life  in  the  tropics  as  to  warrant  them  to 
speak  with  authority,  that  alcohol  wreaks  more  injury  on  the  human 
organism  than  in  temperate  climes.  This  may  be  so,  but  the  evidence 
forthcoming  does  not  appear  to  be  entirely  convincing.  It  is  assuredly 
true  that  in  bygone  days  both  meat  eating  and  heavy  drinking  were  the 
custom  in  the  tropics,  as  elsewhere,  and  that  the  consequences  were  in  a 
high  degree  injurious.  Even  now  it  is  said  that  in  some  tropical  lands, 
East  Africa,  for  instance,  the  white  men-  eat  unsuitable  food,  drink  to 
excess,  and  suffer  accordingly.  In  India  this  is  the  exception  rather  than 
the  rule.  There  the  white  man  is  generally  absteminous  with  correspond- 
ingly good  results.  Exactly  the  same  thing,  however,  has  occurred  in 
Europe,  and  especially  in  Great  Britain.  It  is  not  so  very  many  years 
ago,  in  fact,  almost  within  the  memory  of  the  older  members  of  the  com- 
munity, that  gross  feeding  and  heavy  drinking  were  habitual  with  a  large 
proportion  of  the  prosperous  and  well-to-do  in  the  United  Kingdom.  In 
recent  years  such  habits  have  fallen  into  disrepute,  and,  although  spirit 
and  beer  drinking  have  prevailed  in  the  British  Isles,  members  of  the  pros- 
perous and  well-to-do  class,  from  which  the  white  civil  officials  of  India 
and  the  officers  of  the  Army  are  drawn,  no  longer  gorge  themselves  with 
food  and  drink.  As  said  before,  both  in  India  and  Europe  the  results  of 
this  moderation  have  been  exhibited  in  superior  efficiency  of  mind  and 
body. 

However,  the  point  is  as  to  whether  alcohol  is  more  harmful  in  tropical 
climates  than  in  temperate  countries.  Manson  says  that  the  abuse  of 
alcohol  and  condiments  is  a  fniitful  cause  of  digestive  derangements 
and  of  various  diseases  in  tropical  climates,  but  so  is  the  abuse  of 
alcohol  and  of  indigestible  foods  in  colder  lands.  The  majority  of  authori- 
ties are  of  the  opinion  that  alcohol  is  more  injurious  in  the  tropics  or,  at 
any  rate,  they  strongly  urge  against  the  use  of  alcohol  and  usually  advise 
white  men  sojourning  there  to  be  abstainers. 

The  late  Dr.  Charles  Woodruff,  who,  as  mentioned  previously,  com- 
bated the  crystallized  view  that  the  meat  part  of  the  white  men's  dietary 
should  be  decreased  in  the  tropics,  also  stoutly  defended  the  use  of  alcohol 
in  strict  moderation  in  both  the  tropics  and  in  other  portions  of  the  globe. 
Among  the  numerous  statistics  ho  brings  forward  and  the  many  authori- 
ties he  cites,  is  a  statement  made  by  Dr.  Leon  Meunier  of  Paris,  published 
in  the  Cosmos^  July  14th,  1903,  that  with  regard  to  small  amounts  of 


ALCOHOL  AND  BEVERAGES  IN  THE  TROPICS       403 

alcohol  the  experience  of  centuries  was  to  tlie  effect  tluit  such  an  amount 
is  not  only  harmless,  but  is  a  beneficial  food,  which  can  take  the  place  of 
an  equal  energy  in  butter  and  similar  fuels,  irrespective  of  the  state  of  rest, 
work  or  any  circumstance  relating  to  the  consumer.  Woodruff  goes  on 
to  say  that  the  great  majority  of  the  medical  profession  have  reached  the 
decision  that  alcohol  is  like  every  other  chemical,  whether  it  be  a  poison 
like  strychnin  or  a  food  like  protein;  that  is  to  say,  there  is  an  amount 
below  which  it  is  not  a  poison  and  above  which  it  is  poisonous.  Wood- 
ruff's array  of  figures  and  authorities  seems  to  bear  out  his  own  view,  that 
in  the  terribly  depressing,  anemic  conditions  brought  about  by  living  in  a 
tropical  climate,  against  whose  onslaughts  he  has  no  protection  like  the 
dark-skinned  native,  a  white  man  who  is  not  assisted  by  a  little  alcohol  is 
more  harmed  by  the  climate  than  the  man  who  is  so  aided. 

Simpson  does  not  commit  himself  to  the  expression  of  any  very  decided 
opinion  on  the  subject,  but  gives  this  guarded  statement,  that  it  is  safest 
for  the  newcomer  to  abstain  from  alcoholic  beverages,  especially  so  if  much 
exposure  to  the  sun  is  to  be  endured.  Tea  and  coffee  are  the  customary 
drinks  of  many  of  the  inhabitants  of  the  tropics,  and  where  these  are  not 
in  use,  water  is  generally  the  only  beverage.  He  thinks  it  is  well  to 
follow  the  custom  of  the  country  in  this  respect.  When  alcoholic  drinks 
are  used — and  they  are  often  found  necessary  to  the  European  after  he 
has  been  some  years  in  the  tropics — they  should  only  be  taken  at  meals, 
preferably  with  the  dinner  in  the  evening,  and  then  in  extreme  mod- 
eration. 

Lukis  and  Blackham  are  of  the  opinion  that  "a  certain  amount  of 
alcohol  may  be  safely  consumed  as  a  heat-producing  food."  This  amount 
is  certainly  very  limited,  not  more  than  one  or,  at  the  outside,  two  ounces 
in  twenty-four  hours.  Its  unsuitability  as  a  food  is  shown  by  its  other 
effects  on  the  body  which  are  so  well  known  as  to  need  no  description,  and 
which,  in  fact,  have  been  fully  described  in  the  section  of  this  book  dealing 
with  stimulants.  It  is  allowable  in  some  cases  when,  for  some  reason,  in- 
sufficient food  is  taken.  When  sufficient  food  is  taken,  alcohol  is  unneces- 
sary, and  when  excess  of  food  is  taken  the  addition  of  alcohol  may  do 
serious  harm.  It  may  also  be  said — and  this  point  has  been  elaborated  in 
the  section  on  alcohol — that  this  stimulant  is  exceedingly  valuable  in 
cases  of  exhaustion  arising  from  sickness  or  fatigue,  because  of  its  anes- 
thetic effect.  This  property  of  alcohol  would  seem  to  have  been  proved 
times  without  number.  Wlien  very  hard  work  has  been  done  under  ad- 
verse climatic  conditions,  and  when  extreme  fatigue  supervenes  as  a  result 
of  the  excessive  expenditure  of  muscular  energy,  and  the  vital  forces  are 


404  DIET    IX    HEALTH 

brought  to  a  very  low  ebb,  alcohol  acts  as  an  anesthetic  and  one  forgets 
his  depression. 

However,  the  present  tendency  perhaps  of  scientific  and  military 
authorities  is  to  frown  upon  the  habitual  use  of  alcohol  in  the  tropics  and 
to  deprecate  even  its  use  as  a  spur  in  cases  of  exhaustion.  Kitchener,  it  is 
said,  would  not  permit  soldiers  under  his  command  in  the  Soudan  cam- 
paign to  take  alcohol,  and  substituted  tea,  coffee  or  cocoa.  Sir  R.  Have- 
lock  Charles,  a  soldier  of  wide  tropical  experience,  recorded  his  opinion 
in  The  Practitioner,  1910,  that  alcohol  is  absolutely  unnecessary,  and  if 
taken  at  all  should  be  as  a  luxury.  Tibbies  says  that  it  is  admitted  by  all 
authorities  that  the  use  of  alcohol  in  the  tropics  is  a  matter  requiring 
grave  consideration,  and  that  men  are  better  in  health  and  can  perform 
their  duties  more  satisfactorily  without  it.  Cantlie  wrote  that  the  natives 
of  warm  climates,  both  by  their  religion  and  their  habits,  shun  alcohol. 
This  statement  must  be  taken  with  a  certain  amount  of  reservation.  The 
Mohammedan  religion  is  against  the  use  of  alcohol,  but  in  India  and  else- 
where many  Mohammedans  drink  when  they  can  afford  to  do  so,  and  pos- 
sibly the  chief  deterrent  to  the  use  of  alcohol  is  the  extreme  poverty  of 
the  mass  of  the  tropical  population. 

All  those  who  have  studied  the  question  either  from  the  practical  or 
scientific  standpoint  are  agreed  on  the  point  that  if  alcohol  be  taken  at  all 
in  the  tropics,  it  should  be  drunk  in  moderation  and  even  sparingly. 
Lukis  and  Blackham  say  that  in  hot,  moist  (that  is,  tropical)  climates, 
beer  can  rarely  be  taken  with  impunity,  but  that  no  harm  is  done  by  light 
wines  (white  or  red),  champagne  and  good  whiskey  well  diluted  and 
taken  either  with  meals  or  after  excessive  fatigue  in  small  quantities.  On 
the  contrary,  it  is  evident  that  a  weak  "peg"  or  glass  of  wine  with  the 
evening  meal  is  beneficial  to  the  harassed  Indian  official  at  the  end  of  a 
strenuous  day's  work.  It  promotes  digestion  and  has  a  soothing  effect  on 
the  nerves.  Wliat  does  most  harm  in  India  and  in  other  parts  of  Asia 
where  white  men  congregate  is  the  practice  of  "pegging,"  or  of  taking 
"short  drinks"  at  the  club  bar  before  dinner.  It  is  obvious  that  spirits, 
if  as  harmful  as  many  scientists  say,  are  less  harmful  when  freely  diluted. 
Therefore,  when  drunk  customarily,  and  not  wholly  employed  as  a  spur 
in  cases  of  exhaustion,  they  should  be  well  diluted  and  taken  in  strict 
moderation.  Tibbies  says  "that  about  half  a  pint  of  red  wine  or  one  pint 
of  beer  daily  is  considered  a  fair  allowance,  but  he  is  of  the  opinion  that 
even  such  a  modicum  is  better  replaced  by  tea,  coffee,  cocoa  or  their  sub- 
stitutes, caffer  tea,  dorn-the,  gooranut,  kola,  kat,  mote,  guarana,  and  other 
native  beverages."    Natives  in  all  tropical  climates,  when  not  debarred  by 


ALCOHOL  AND  BEVERAGES  IK  THE  TROPICS       405 

poverty  or  restrained  by  religious  scruples,  drink  spirituous  beverages  of 
domestic  manufacture.  These  are  made  from  any  article  of  food  which 
will  ferment.  Whether  made  in  South  America,  in  Asia,  or  in  Africa, 
they  are,  generally  speaking,  deadly  to  the  natives  and  more  deadly  to  the 
white  men  who  are  foolish  enough  to  partake  of  them.  This  has  been 
proven  by  the  disastrous  experience  of  American  soldiers  in  the 
Philippines. 

^Native  drinks  are  many  and  various.  Doasta  distilled  from  rice  liquor 
is  sold  in  Calcutta.  Mann  states  that  it  is  20  degrees  under  proof,  but 
contains  0.56  per  cent  of  higher  alcohols  or  491  grains  per  gallon.  Sugar 
refuse  yields  a  liquor  known  as  Shajehanjur  rum,  which  is  sold  53  to  50 
degrees  under  proof.  In  Bengal  and  Assam,  the  flowers  of  Bassia  latifolia 
contribute  a  spirit  named  Mahua.  It  is  sold  22  to  50  degi'ees  under  proof, 
and  contains  0.004  to  0.33  per  cent  of  higher  alcohols  and  is  a  very  poi- 
sonous and  deleterious  concoction  even  to  the  natives.  The  notorious 
arrack  is  distilled  from  the  sap  of  the  palm  tree  in  India  and  Ceylon,  but 
the  characteristic  which  has  given  it  its  evil  name  is  the  fact  that  it  is 
frequently  drugged.  Other  vile  beverages  are  fairly  common  among  the 
inhabitants  of  Asia  and  other  tropical  countries.  Some  of  these  native 
drinks  are  less  harmful  than  the  European  spirits,  but  some  of  them  are 
most  pernicious. 

It  is  difficult,  indeed  impossible,  to  write  dogmatically  with  regard  to 
the  effects  of  the  imbibing  of  alcohol  in  the  tropics,  or  to  state  definitely 
that  it  is  more  injurious  to  the  human  being  there  than  in  temperate 
climates.  Drinking  to  excess  is  harmful  everywhere,  and  its  baneful 
effects  are  too  plainly  evident  in  every  civilized  land.  Two  reasons,  and 
these  not  scientific  ones,  why  white  men  should  be  abstemious  as  regards 
alcohol,  in  the  tropics,  are  that  by  so  doing  they  set  a  good  example  to  the 
natives  and  that  if  they  drink  more  than  is  good  for  them  they  are  apt 
to  deteriorate  more  quickly  in  the  tropics  than  in  a  colder  climate. 

While  the  last  word  has  not  been  said  on  the  question  of  alcohol  as 
a  beverage,  it  must  be  confessed  that  the  weight  of  scientific  evidence  is 
on  the  side  of  those  who  contend  that  the  use  of  alcohol  is  almost  always 
contra-indicated.  Some,  like  Horsley,  say  always.  Nevertheless,  there  is 
a  large  number  of  men,  few  of  whom  perhaps  are  of  so  high  a  scientific 
caliber  as  the  opponents  of  alcohol,  but  who  have  had  more  practical  expe- 
rience, who  hold  that  alcohol  has  its  value  and  that  its  use  as  a  beverage 
should  not  be  entirely  barred.  Problems  of  this  kind  cannot  be  wholly 
solved  in  the  laboratory.  The  argument  that,  because  an  undue  proportion 
of  a  population  undergoes  deterioration,  mental  and  physical,  through 
126 


406  DIET    IN    HEALTH 

driuk,  it  should  be  abolished,  may  be  good  and  sound  from  the  scientific 
point  o±  view,  but  it  may  not  be  an  altogether  practical  position  to  take. 

There  is  one  feature  in  connection  with  the  consumption  of  alcoholic 
beverages  in  the  tropics  of  which  little  notice  seems  to  have  been  taken. 
This  is,  that,  owing  to  the  heat,  elimination  and  excretion  are  more  pro- 
fuse and  rapid  by  far  than  in  cold  climates.  Consequently  it  is  reasonable 
to  suppose  that  alcohol  will  pass  out  of  the  system  more  quickly  and  do 
less  harm  than  in  more  frigid  lands.  It  is  acknowledged  that  the  most 
injurious  effects  of  alcohol  are  on  the  nervous  system,  rendered  possible 
by  prolonged  poisoning. 

Dr.  Winfield  Scott  Hall  points  out(30)  that  the  theory  that  alcohol  is 
a  food  is  disproved  by  recent  researches.  All  life  activity  is  accompanied 
by  oxidation,  and  all  oxidation  by  waste.  Any  sparing  action  which  alco 
hol  may  possess  is  easily  accounted  for  as  being  in  harmony  with  its  gen- 
erally accepted  narcotic  action.  Narcotic  action  is  followed  by  decreased 
activity,  therefore  decreased  oxidation,  therefore  "sparing."  Nobody  has 
contended,  much  less  proven,  that  this  so-called  sparing  action  is  an  econ- 
omy of  food  material  in  connection  with  activity.  With  the  influence  of 
alcohol  as  without  it,  a  given  amount  of  life  activity  is  accompanied  by  a 
given  consumption  of  body  substance,  and  it  is  inane  and  foolish  to  con- 
tend that  the  sparing  action  of  alcohol,  due  to  its  narcotic  effect,  should 
be  accepted  as  an  argument  proving  its  food  value. 

The  oxidation  of  alcohol  liberates  heat  energy,  but  this  energy  cannot 
be  utilized  by  the  body,  even  for  the  maintenance  of  body  temperature. 
If  a  food  is  defined  as  a  substance  which,  taken  into  the  body,  is  assimi- 
lated and  used  either  to  build  up  or  repair  body  structure,  or  to  be 
oxidized  in  the  tissues  to  liberate  the  energies  used  by  the  tissues  in  their 
normal  activity,  then  alcohol  is  not  a  food.  If  alcohol  is  not  a  real  food, 
what  is  the  significance  of  its  oxidation  ?  It  has  long  been  known  that 
the  liver  produces  oxidases,  and  that  it  is  the  site  of  active  oxidation  of 
mid-products  of  catabolism,  of  toxins,  and  of  other  toxic  substances. 
Alcohol,  while  usually  formed  as  an  excretion  of  the  yeast  plant,  is  also 
found  as  a  mid-product  of  tissue.  It  belongs  clearly,  then,  to  the  group  of 
excreta.  Experiments  conducted  by  Dr.  Reid  Hunt  and  other  experi- 
ments carried  out  by  Dr.  Beebe  prove  with  sufficient  clearness  that  alcohol 
is  a  toxic  substance  and  not  a  food  in  any  sense.  With  regard  to  alco- 
holic beverages.  Hall  has  this  to  say: 

Aleohofie  beverages  contain  from  3  per  cent  to  40  per  cent  of  ethyl  alcohol. 
Beers  and  ales  contain  the  lower  percentages  of  alcohol ;  whiskey,  mm  and  brandy 
the  higher  percentages,  while  wines  are  about  midway  between. 


ALCOHOL  AND  BEVERAGES  IN  THE  TKOPICS       407 

No  alcoholic  beverage  has  so  low  a  })erceiitage  of  alcohol  as  to  be  with- 
out danger.  The  aiiioiiiit  imbibed  by  the  addict  is  usually  so  much  that 
the  alcohol  taken  exceeds  the  "physiological  limit,"  that  is,  there  is  more 
alcohol  taken  than  can  be  oxidized  in  the  liver,  so  that  there  is  an  escape 
into  the  general  system  not  only  of  deleterious  toxins,  which  should  have 
been  oxidized  in  the  liver,  but  also  of  the  excess  of  alcohol,  which  is  C9,r- 
ried  to  brain  and  to  muscles,  seriously  disturbing  their  normal  activity 
and  decreasing  their  elhciency. 

The  evidence,  on  the  whole,  gathered  from  the  views  of  authorities  on 
tropical  hygiene,  appears  to  point  in  the  direction  of  abstinence  from 
liquor  or  strict  moderation  in  its  use  in  the  tropics.  The  arguments,  how- 
ever, in  support  of  complete  abstention  from  alcoholic  beverages  are  no 
more  decisive  as  regards  the  tropics  than  they  are  with  respect  to  temper- 
ate climates.  It  is  true  that  scientific  and  public  opinion  are  veering 
towards  the  view  that  alcohol  is  unnecessary  and  ofttimes  very  harmful; 
therefore,  it  may  be  stated  that  when  the  opinions  of  various  authorities 
on  the  subject  of  alcohol  in  the  tropics  have  been  carefully  considered,  the 
preponderant  view,  at  any  rate,  from  the  scientific  standpoint,  seems  to 
be  that  its  use  is  unnecessary,  and,  when  it  is  recognized  that  its  abuse  is 
injurious,  the  best  means  of  avoiding  harm  is  to  abstain  from  it  entirely. 

Among  other  beverages  largely  used  in  the  tropics,  tea  is  the  most 
popular,  but  coffee,  cocoa  and  aerated  drinks  are  consumed  largely.  The 
properties  of  all  these  beverages  have  been  amply  discussed  in  the  section 
dealing  with  beverages. 

REFERENCES 

1.  Gautikh.     Diet  and  Dietetics,  tr.   by  A.   J.  Rice-Oxley,  2nd  ed., 

Lippincott,  ll)()(). 

2.  Hutchison.     Food  and  the  Principles  of  Dietetics,  4th  ed.,  Wood, 

1917. 

3.  Chittenden.     Physiology  of  Man. 

4.  Benedict,  A.  L.     Golden  Rules  of  Dietetics. 

5.  Speck.     Arch.  f.  exp.  Pathol,  u.  Pharm.,  Bd.  xv,  p.  81. 
r..     VoiT,  C.     Ztschr.  f.  Biol.,  Bd.  xiv,  p.  57. 

7.  Maurel  (of  Toulouse).     Influence  des  climats  et  des  saisons  sur  les 

depenses  de  I'orgariisme  chez  I'homme. 
Arch,  de  med.  nav.,  vol.  Ixxiv,  p.  366 ;  vol.  Ixxv,  pp.  5,  81. 

8,  Dk  Loxfj,  Gkok'ok  W.     Voyage  of  the  Tcaunette. 


408  DIET    IN    HEALTH 

U.  Bull.  No.  227,  Exper.  Station,  U.  S.  Dept.  of  Agric. 

10.  .     Ibid.,  No.  27. 

11.  Davis.     Foods  in  Health  and  Disease. 

12.  Playfair.     Text-book  of  Physiology. 

13.  TiBBLES,  Wii-LiAM.     Food  in  Health  and  Disease. 

14.  Hutchison.     Food  and  the  Principles  of  Dietetics. 

15.  Atwatee.    U.  S.  Dept.  of  Agric.,  Bull.  No.  38. 

16.  .     Report  of  U.  S.  Commisisoner  of  Fish  and  Fisheries. 

17.  Chittenden,  R.  H.     Nutrition  of  Man. 

18.  Melville,  Col.    Brit.  Med.  J.,  1910,  vol.  ii,  p.  1337. 

19.  Tibbles,  William.     Food  in  Health  and  Disease. 

20.  Atwater  and  Wood.    U.  S.  Dept.  of  Agric,  Bull.  No.  38. 

21.  Hoffman.     Food  of  the  Negro  in  Alabama,  U.  S.  Dept.  of  Agric. 

Bull.  No.  38. 

22.  Goss,  Arthur.     Dietary  Studies  in  New  Mexico,  U.  S.  Dept.  of 

Agric,  Bull.  No.  40. 

23.  Davis.     Food  in  Health  and  Disease. 

24.  Manson.     Tropical  Diseases. 

25.  Woodruff,  Charles.     American  Medicine,  1914. 

26.  LuKis  and  Blackham.     Text-book  Tropical  Hygiene,  2nd  ed. 

27.  Holy  Bible     1st  Cor.,  16th  chap.,  22nd  verse 

28.  Simpson.     Principles  of  Hygiene  as  Applied  to  Tropical  and  Sub- 

Tropical  Countries,  Wood,  1908. 

29.  Manson.     Sutherland's  System  of  Diet  and  Dietetics. 

30.  Hall,  Winfield  S.     Med.  Times,  Feb.,  1916. 


CHAPTER    XIII 
DIET    m    CRITICAL   PHYSIOLOGICAL    PERIODS 

Old  men  hear  want  of  food  best;  then  those  that  are  adults;  youths  hear  it 
least,  most  especially  children,  and  of  them  the  most  lively  are  the  least  capable  of 
enduring  it. 

Diet  in  Childhood:   Early  Childhood;  Diet  for  School  Children. 

Diet  during  Puberty. 

Diet  in  Sedentary  Occupations. 

Diet  during  Menstruation. 

Diet  during  Pregnancy. 

Diet  during  the  Puerperiura. 
Diet  during  Lactation. 
J)iet  during  the  Menopause. 
Diet  in  Old  Age. 

DIET   IN    CHILDHOOD 

In  this  chapter  no  reference  will  be  made  to  the  alimentation  for  the 
infant,  as  this  will  l)e  fully  discnssed  in  subsequent  chapters.  We  will 
begin  with  early  childhood  (from  the  third  to  the  sixth  year  before  school), 
during  which  time  the  child  should  have  four  meals  each  day  and  a  nap  in 
the  afternoon.  There  should  be  no  sudden  change  of  diet  during  this 
period,  but  the  proportions  of  milk  should  be  gTadually  decreased  and 
mushy  cereals  increased,  and  a  greater  proportion  of  breadstutfs,  cookies, 
etc.,  shonld  be  allowed.  According  to  the  researches  of  Atwater,  at  the 
end  of  the  second  year  the  child  weighs  about  one-fifth  as  much  as  the 
adult,  and  requires  three-tenths  of  the  standard  adult  ration,  the  relative 
excess  being  due  to  the  fact  that  the  child  is  growing  and  depositing  tissues 
and  fat.  From  the  third  to  the  fifth  year  the  growing  child  requires  four- 
tenths  of  the  adult  ration;  from  the  sixth  to  the  ninth  year  one-half,  and 
from  the  tenth  to  the  thirteenth  year  six-tenths.  From  this  age  on  much 
depends  upon  the  habits  and  life.  For  instance,  a  girl  from  fourteen  to 
sixteen  requires  seven-tenths  of  the  adult  ration,  and  a  boy  of  the  same 

age  requires  a  full  adult  ration. 

409 


410 


DIET    IN    PHYSIOLOGICAL   PERIODS 


Early  Childhood. — Dr.  M.  Allen  Starr  (1)  has  worked  out  the  accom- 
panying table  of  the  dietetic  needs  in  childhood  collected  from  the  actual 
food  consumption  by  large  groups  of  healthy  children. 

STARR'S  TABLE  OF  DIETETIC  NEEDS  IN  CHILDHOOD 


2-3  years 

(28  cases) 

3-6  years 
(12  cases) 

4-10  years 
(24  cases) 

Bread 

7.5    ounces 

.98      " 
4.6 
3.9 
32.6 

10.3    ounces 

1.08      " 
12.1 
13. 
48.6 

10.23  bunces 

Butter 

.99      « 

Beef 

12.46      « 

Potatoes  or  rice 

10.23      " 

Milk 

38.5 

Cereals,  fruits  and  eggs  should  enter  largely  into  the  composition  of 
the  alimentation  of  the  growing  child,  and  there  is  no  objection  to  an  allow- 
ance of  a  minimum  amount  of  meat.  During  this  period  of  development, 
from  the  third  to  the  sixth  year,  the  child  is  building  up  tissue,  muscle, 
brain,  bone  and  gland,  and  must,  therefore,  have  plenty  of  protein.  Milk, 
eggs  and  cereals  will  furnish  these  in  abundance.  At  this  time,  also,  the 
child  is  acquiring  habits,  and  it  should  be  impressed  upon  him  that  the 
habit  of  proper  mastication  is  an  important  acquisition.  This  can  only 
be  attained  by  necessity.  The  mother  should  be  instructed  not  to  feed 
the  child  on  a  diet  consisting  too  largely  of  pultaceous  foodstuffs  of  a  semi- 
liquid  character,  as  these  will  be  swallowed  without  chewing  and  thereby 
become  a  hindrance  to  dental  development  and  a  possible  detriment  to  the 
development  of  the  digestive  organs.  Such  a  diet  leads,  in  the  first  place, 
to  imperfect  development  of  the  muscles  of  mastication  and  the  jaws,  with 
the  result  that  the  post-nasal  space  is  small  and  liable  to  be  encroached 
upon  by  adenoids,  with  unfavorable  effects  upon  growth  and  general  nutri- 
tion, while  in  the  second  place  the  particles  of  carbohydrate  food  will  lodge 
around  the  teeth  and  undergo  acid  fermentation  with  resulting  dental 
caries.  The  great  necessity  for  giving  the  child  food  that  requires  chew- 
ing cannot  be  too  strongly  emphasized.  The  healthy  gTowung  child  will 
get  hungry  between  meals,  and  if  he  is  doled  out  soft  bread  with  jam  he  is 
pretty  certain  first  to  swallow  the  food  with  inadequate  chewing  and,  sec- 
ond, to  eat  more  than  he  needs,  overloading  his  stomach,  overtaxing  his 
digestive  activities,  and  perhaps  retarding  his  appetite  for  the  next  meal. 
This  point  is  particularly  emphasized  by  Watson (2),  who  urges  that  a 
child  be  taught  early  to  develop  the  art  of  mastication,  which  favors  the 
normal  development  of  the  nasal  and  nasopharyngeal  cavities  which  are  of 


DIET    IN    CHlLDHOOi)  411 

so  much  importance,  for  the  purpose  of  respiration  and  general  nutrition. 

The  cereal  foods  are  of  first  importance — oatmeal,  hominy  and  samp, 
thoroughly  cooked  and  served  with  butter,  cream,  milk  or  sirup.  Well- 
cooked  farinaceous  puddings  of  all  kinds  are  wholesome  and  readily  taken 
by  children. 

Of  fresh  vegetables  the  potato  is  the  most  popular,  and  one  of  which 
young  children  will  not  tire.  It  may  be  served  boiled,  baked  or  mashed 
and  creamed,  but  never  fried.  Fresh  cauliflower,  cabbage,  spinach, 
asparagus,  beans  and  peas  may  be  allowed,  but  canned  vegetables  should 
never  be  used  when  fresh  ones  can  be  had. 

We  fully  appreciate  the  craving  of  the  growing  child  for  sugar,  candy 
and  sweets,  a  demand  which  must  be  satisfied.  It  is  far  better  to  do  this, 
however,  by  the  use  of  sugar  in  the  food  than  by  allowing  the  artificially 
colored  sweets  of  the  candy  manufacturer,  which  are  often  taken  in  ex- 
cess apart  from  the  meal.  Many  fruits  contain  a  considerable  amount  of 
sugar  in  an  assimilable  form,  as  well  as  certain  mineral  properties  which 
are  of  inestimable  value  and  importance  in  maintaining  a  healthy  condi- 
tion of  the  blood.  Apples,  peaches,  pears,  plums,  grapes,  oranges,  bananas, 
cherries,  etc.,  are  suitable  wholesome  fruits,  and  some  of  these,  according 
to  season,  should  form  a  part  of  the  child's  dietary  each  day. 

The  first  permanent  molar  teeth  appear  about  the  sixth  year,  while 
the  deciduous  incisors  are  already  undergoing  decay.  Children  at  this 
stage  require  careful  preparation  of  food  by  fine  cutting,  scraping,  etc. 
At  this  time,  also,  the  child  should  be  initiated  into  the  use  of  the  tooth- 
brush, and  if  necessary  the  dentist  should  be  consulted  as  to  the  preserva- 
tion even  of  the  deciduous  teeth  by  means  of  temporary  soft  fillings.  Not 
only  are  these  deciduous  teeth  more  valuable  for  mastication  than  parents 
sometimes  think,  but  with  cavities  they  furnish  a  home  for  the  colonization 
of  bacteria,  which  hasten  the  early  loss  of  the  permanent  teeth. 

The  normal  day's  ration  for  a  healthy  child  of  four  to  six  years,  ac- 
cording to  Hall,  may  be  as  follows(3),  necessary  variations  being  made 
in  accordance  with  the  season,  climate,  etc. : 

Breakfast — 7  a.m. 

A  glass  of  whole  milk;  small  portion  of  thoroughly  cooked  oatmeal  with  cream 
and  sugar;  baked  apple;  small  piece  of  buttered  toast. 

Lunch — 10  A.M. 

A  small  portion  (equal  to  a  heaping  tablespoon)  of  parched  sweet  corn,  or  two 
graham  crackers;  glass  of  water. 

Dinner — 1  p.m. 

Cup  of  cambric  tea  (hot  water  and  cream  sweetened);  bread  and  butter;  creamed 
potatoes;  fruit,  stewed  or  fresh, 


412 


DIET    IN   PHYSIOLOGICAL   PERIODS 


Tea — 4  p.m. 

A  dry  crust  or  a  piece  of  cold,  dry  toast,  or  a  pretzel,  or  two  graham  crackers. 
Supper — 6  p.m. 

Glass  of  milk;  soft-boiled  egg;  shredded- wheat  biscuit  with  cream;  fruit  (apple, 
grapes,  banana  or  orange). 

There  are  several  points  in  reference  to  a  child's  diet  which  should  be 
specially  emphasized,  as  pointed  out  by  Hall.  First,  his  food  should  bo 
dry  and  hard  to  chew.  Second,  one  meal  each  day  should  be  rich  in  pro- 
teins. Third,  any  lunches  partaken  of  in  the  midforenoon  or  midafter- 
noon  should  be  small  in  volume  and  should  always  be  dry,  requiring  very 
slow  mastication,  which  will  insure  the  ingestion  of  small  quantities  and 
rapid  digestion.  Furthermore,  such  a  repast  will  not  interfere  with  the 
full  meal  which  is  to  follow  some  two  hours  later.  A  normal  child  of  two 
years  and  upwards  has  a  well-developed  digestive  apparatus  and  a  keen 
appetite,  and  is  well  able  to  digest  most  foodstuffs  if  given  in  moderate 
quantities. 

Watson  has  compiled  a  very  practical  table  of  average  weights  and 
heights  of  children  at  different  ages.  The  averages  in  these  tables  were 
calculated  from  weights  and  measurements  taken  from  a  large  number  of 
observations,  and,  though  fairly  accurate,  are  not  necessarily  true  in  all 
cases.  The  discrepancy,  however,  will  not  vary  more  than  15  per  cent 
either  way.  The  point  of  greatest  importance  is  the  proportion  between 
height  and  weight.  To  be  exact  in  recording  observations  in  weight,  the 
periodical  weighing  should  be  done  under  precisely  corresponding  condi- 
tions, the  same  clothes,  same  scales,  etc. 

COMPARATIVE  HEIGHTS  AND  WEIGHTS  OF  CHILDREN 


Males 

Females 

Age  last 

Age  last 
birthday 

birthday 

Height 

Weight 

Height 

Weight 

1 

2  ft.    5}4  in. 

183^  lbs. 

1 

2  ft.    3M  in. 

18      lbs. 

2 

2    «     8^   « 

32H     " 

2 

2    «      7       « 

251^     " 

3 

2    "    11 

34 

3 

2    «    10 

31M     " 

4 

3    "      1 

37 

4 

3    «      0 

36 

5 

3    «      4 

40 

5 

3    "     3 

39 

6 

3    "     7       " 

44K     " 

6 

3    "     6 

413^    « 

7 

3    "    10 

493^     " 

7 

3    "     8 

47H     " 

8 

3    «    11 

55 

8 

3    "    101^   " 

52 

9 

4    "      1^   « 

60H     " 

9 

4    «      OH   " 

53H     " 

10 

4    "     3M   " 

671^     « 

10 

4    "      3 

62 

11 

4    «     5}4   " 

72 

11 

4    "     5       " 

68 

12 

4    «     7 

76^     « 

12 

4    «     7J^   " 

76H     " 

1.3 

4    "      9       « 

82H     " 

13 

4    «     9M   " 

87 

DIET    IN    CHILDHOOD  413 

A  point,  emphasized  by  Watson,  and  often  overlooked  at  this  period 
of  life,  is  the  necessity  for  adapting  the  alimentation  to  the  diathesis  of 
the  child.  For  instance,  the  needs  of  a  child  of  tuberculous  parents,  say, 
at  the  fifth  year,  are  different  from  those  of  a  gouty  child  of  the  same 
age.  The  child  of  a  tuberculous  diathesis  is  usually  of  comparatively 
feeble  development,  shows  little  muscular  activity,  is  slightly  anemic  and 
possibly  under  size.  The  principal  point  in  arranging  the  diet  in  such 
cases  is  to  provide  the  necessary  increase  in  the  amount  of  aniuial  pro- 
tein, more  particularly  meat  and  raw  meat  juice.  The  gTeat  benefit  de- 
rived from  a  properly  planned  alimentation  in  these  cases  is  little  less  than 
remarkable,  but  to  secure  lasting  results,  the  dietary  must  be  religiously 
continued  for  many  months,  sometimes  for  as  long  as  two  years.  The 
following  diet  list  wall  be  found  of  practical  importance  and  suitable  for 
a  child  of  five  or  six  years,  with  a  tuberculous  diathesis.  It  contains  a 
more  liberal  supply  of  animal  proteins  in  the  form  of  milk,  eggs,  meat, 
and  soup  than  an  ordinary  diet,  including  two  pints  of  milk,  and  meat 
foods  at  least  three  times  daily.  This  point  should  be  insisted  on  and 
continued  during  the  growing  period. 

DIETARY  FOR  TUBERCULOUS  CHILDREN 

First  Breakfast — 6.30  a.m. 
Milk;  biscuit  and  butter. 

Breakfast: 

Milk;  butter;  bread;  egg;  fish  or  bacon. 

Lunch: 

Cup  of  soup  (meat  stock),  or  egg  flip. 

Dinner: 

Soup  with  raw  meat;  curds  and  cream;  glass  of  milk;  pounded  meat  and  vege- 
table; stewed  fruit  cream;  glass  of  milk.     Fish,  with  sauce;  potato;  custard 
pudding;  glass  of  milk.    Chicken,  bread  sauce;  vegetable;  blancmange;  cream; 
glass  of  milk. 
Tea: 

Milk;  bread  and  butter. 

Supper: 

Good  meat  soup,  thickened  with  milk;  or  egg;  or  meat  pur6e;  or  lentil  pur6e. 

The  diet  for  a  child  of  the  gouty  diathesis  should  be  most  carefully 
regulated,  since  it  is  without  question  that  proper  alimentation  will  do 
much  to  eradicate  the  tendency  to  disease.  "The  special  features  in  the 
dietary  treatment  are  (a)  the  necessity  of  bringing  the  child  up  on  a 
strictly  lacto-vegetarian  diet,  red  meats  of  all  kinds  to  be  forbidden,  or, 
at  most,  only  allowed  occasionally,  and  very  spariugly ;  (h)  the  importance 
of  a  restricted  allowance  of  sugar  and  of  foodstuffs  rich  in  sugar.     If  a 


414  DIET    m   PHYSIOLOGICAL   PERIODS 

child  with  a  gouty  tendency  is  dieted  along  these  lines  during  the  period 
of  growth  and  development,  he  will  be  much  less  prone  to  develop  gouty 
symptoms  in  later  life." 

Diet  for  School  Children. — Growing  boys  and  girls  during  school  life 
from  the  sixth  year  until  puberty  require  a  large  amount  of  wholesome, 
nutritious  food (4).  During  this  stage  of  life  the  rapid  growth  and  inces- 
sant activity  of  the  child  continue,  and  to  these  is  now  added  the  mental 
work  of  laying  the  foundation  for  an  education.  In  a  child  that  has  been 
wisely  brought  up  under  normal  conditions  and  has  had  a  due  amount  of 
work,  play  and  sleep,  the  appetite  will  be  the  best  guide  for  the  amount  of 
food  required.  On  the  other  hand,  the  appetite  of  a  child  who  has  been  in- 
dulged with  too  many  sweets  and  highly  seasoned  dishes,  to  the  exclusion 
of  the  plainer,  more  wholesome  foods,  and  who  has  been  petted,  pampered 
and  brought  up  like  a  hothouse  plant,  will  not  be  a  trustworthy  guide  to 
the  food  requirements.  Children  with  a  debased  appetite  of  this  sort, 
which  is,  of  course,  due  to  faulty  feeding  at  home,  had  better  be  sent  to 
a  boarding  school  at  once,  where  the  social  customs  will  soon  effect  a  per- 
fect, if  at  first  a  somewhat  painful,  cure.  It  is  not  uncommon  at  this  age 
to  have  the  parent  tell  us  that  "Johnny  cannot  take  this  and  cannot  take 
that  food  at  home,"  although  on  physical  examination  no  defects  will  be 
found.  It  cannot  be  too  strongly  impressed  on  parents  that  the  inability 
of  healthy  children  to  take  ordinary  food  is  imaginary,  brought  about 
largely  by  previous  erroneous  feeding  and  fostered  by  paternal  weakness, 
proof  of  which  is  furnished  by  the  fact  that  when  the  child  is  placed 
among  other  children  who  are  eating  ordinary  food  this  inability  at  once 
passes  away.  It  must  not  be  lost  sight  of,  however,  that  we  not  infre- 
quently meet  with  a  neurotic  boy  or  girl  with  personal  idiosyncrasies  to 
certain  articles  of  diet.  Such  children  require  special  study  and  special 
treatment. 

The  greater  the  amount  of  exercise  a  child  takes  in  the  open  air,  the 
greater  will  be  his  appetite,  which  will  directly  influence  the  quantity  of 
food  he  should  take.  Strenuous  exercise  up  to  the  moment  of  coming  to 
meals  should  not  be  allowed,  as  such  exercise  is  liable  to  produce  exhaus- 
tion, which  will  affect  both  appetite  and  digestion.  The  normal  adult  likes 
to  indulge  in  a  short  rest  after  meals,  but  the  healthy  child  will  be  eager 
for  exei'cise,  which  should  not  be  forbidden,  provided  it  is  the  nature  of 
the  child  to  be  active  in  play  and  not  easily  tired.  Still,  it  is  well  to  re- 
member that  a  strenuous  game  of  football  immediately  after  dinner  is 
distinctly  injurious. 

In  estimating  the  requisite  caloric  value  of  the  dietary  of  children 


DIET    i:^^    CHILDHOOD  415 

some  fonniilse  will  have  to  be  followed  as  a  guide.  Children  of  iioniial 
size,  development  and  activity  Sherman,  thinks  require  the  following 
calories  per  kilogram  of  body  weight 

REQUISITE    CALORIES   PER   KILOGRAM   FOR   VARIOUS   AGES 
From  1  to    2  years  100-90  calories  j^er  kilogram    900  to  1200  calories 


2  «    5 

« 

90-80 

« 

a 

'          1200 

«   1500 

6  «    9 

u 

80-70 

u 

(( 

1400 

«   2000 

10  «  13 

tt 

70-60 

u 

« 

*          1800 

«   2200 

Girls  14  «  17 

tt 

65-45 

a 

(( 

'          2200 

«   2600 

Boys  14  «  17 

u 

60-40 

it 

« 

"          2500 

«   3000 

In  calculating  a  dietary  for  children  the  factors  of  growth  and  devel- 
opment must  always  be  taken  into  consideration.  The  child  needs  pro- 
tein for  the  ordinary  wear  and  tear  and  also  requires  an  additional  amount 
for  the  production  of  bone  and  muscle.  The  child  has  an  intense  metab- 
olism, more  general  than  the  adult;  owing  to  the  period  of  growth  the 
food  must  supply  material  to  be  added  to  the  body  in  the  form  of  bone 
and  brawn  in  addition  to  that  which  is  oxidized  for  normal  metabolism. 

In  selecting  the  proper  alimentation  of  young  subjects,  the  most  im- 
portant consideration  is  that  of  not  starving  the  child  on  any  one  food- 
stuff (5).  A  requisite  amount  of  protein,  fats  and  carbohydrates  is  abso- 
lutely essential.  To  stint  is  very  often  to  starve ;  therefore,  in  arranging 
the  diet,  the  meals  should  be  at  regidar  intervals,  at  least  three  good  meals 
being  given  daily.  The  chief  difference  from  the  feeding  in  the  early 
years  is  that  a  large  amount  of  beef  and  mutton  is  nov/  demanded.  Meat 
should  be  given  twice  a  day,  once  to  provide  for  the  wear  and  tear,  of  the 
body,  and  once  to  "supply  the  means  for  growth,"  as  Dr.  Clement  Dukes 
rather  quaintly  expresses  it.  It  is  needless  to  say  that  the  freshness  of  the 
food  is  a  most  important  consideration.  Salted  meats  and  canned  meats 
are  useful  in  supplying  variety  in  the  dietary,  but  if  used  too  frequently 
they  fail  to  supply  the  proper  amount  of  nutrition  and  their  continued  use 
becomes  monotonous,  leading  to  loss  of  appetite.  Likewise,  canned 
vegetables  and  fruits  are  to  be  considered  as  inferior  to  fresh  ones  for 
regidar  use.  The  question  of  hours  for  meals  is  important.  Breakfast 
should  be  punctual  to  allow  the  child  time  to  eat  a  good  hearty  meal,  to 
masticate  its  food  properly,  and  to  have  time  before  starting  for  school  to 
attend  to  the  bowels.  School  children  are  often  upset  through  neglect  of 
this  wholesome  rule. 

The  value  of  a  liberal  diet  during  school  life  cannot  be  too  strongly 
emphasized.     Dr.  Watson(2)  speaks  with  authority  on  the  subject,  and 


416  DIET    IX    PHYSIOLOGICAL    PERIODS 

the  following  articles  of  food  are  selected  from  those  given  by  him  as 
suitable  at  this  age:  ^ 

SUITABLE  DIETARY  FOR  SCHOOL  CHILDREN 

Breakfast: 

This  should  be  the  heartiest  meal  of  the  day.     Begin  with  a  small  plate  of  por- 
ridge and  glass  of  milk;  follow  by  an  egg  or  fish,  bread  and  butter,  or  toast  and 
butter,  and  tea  or  coffee,  largely  made  with  hot  milk;  jam  or  marmalade  and 
oatcake. 
Lunch — 11.30  a.m. 

A  dry  biscuit  and  a  drink  of  milk  (not  hot  scones,  buns,  or  pastry);  a  little  fresh 
fruit,  apple,  orange,  or  banana. 
Dinner — in  the  middle  of  the  day: 

This  should  consist  of  soup,  meat,  vegetables,  and  pudding.  The  soup  does  not 
require  to  be  made  of  rich  meat  stock — lentil,  pea,  broth,  or  rice  soup  are  all 
excellent,  giving  a  good  foundation  for  the  meat  course.  Roast,  boiled  meat, 
and  stews  are  the  best,  served  always  with  potatoes  and  a  vegetable.  Pud- 
ding should  be  varied:  suet  pudding  with  fruit  or  jam,  milk  puddings,  or  stewed 
fruit.  A  glass  of  miUc  may  be  given  with  this  meal,  and  as  much  bread  as  the 
child  wishes  to  take. 
Tea,  not  later  than  5.30  p.m. 

Beverage,  milk  or  cocoa  (not  tea  as  a  rule) ;  as  much  plain  bread  and  toast  as  the 
child  can  eat;  plain  cake;  sometimes  an  egg,  or  fish,  or  potted  meat,  marma- 
lade, jam,  or  honey. 
Supper: 

A  drink  of  milk  and  a  biscuit  is  all  that  is  necessary;  a  large  supper  is  not  advisable. 
It  is  better  for  all  children  to  go  to  bed  with  the  stomach  comparatively  empty. 

Weak  tea  and  coffee,  well  diluted  with  milk,  may  be  added  to  the 
dietaries  given,  but  should  not  be  taken  in  excess.  ^lilk  at  this  age  will 
be  mado  much  more  palatable  and  attractive  to  the  palate  if  flavored  with 
tea  or  coffee.  The  question  of  an  allowance  of  alcohol  for  schoolboys  may 
be  answered  by  asking  the  question :  "Is  it  necessary,  and  is  it  beneficial  ?" 
The  consensus  of  opinion  of  both  physicians  and  dietitians  has  decided 
both  questions  in  the  negative.  If,  then,  the  use  of  alcohol  by  the  school- 
boy has  been  considered  unnecessary  on  physical  grounds  and  not  bene- 
ficial on  normal  grounds,  one  can  safely  assert  with  confidence  that  alcohol 
should  not  form  a  part  of  the  youth's  diet  during  school  life.  (See  section 
on  Alcohol,  Volume  I,  Chapter  XVI,  page  568.) 

The  chief  meals  of  the  day  should  be  three  in  number :  breakfast,  din- 
ner and  supper.  The  first  two  should  be  the  substantial  meals,  while  sup- 
per should  consist  of  less  stimulating  food.  Under  no  consideration  should 
schoolboys  and  girls  have  a  heavy  meal  of  stimulating  food  a  short  time 
before  retiring.  Neither  should  they  be  set  to  the  task  of  doing  lessons  in 
the  morning  before  partaking  of  food,  but  should  spend  a  half  hour  in  the 
open  air,  after  which  a  substantial  meal  should  be  serv^ed,  with  plenty  of 
time  for  thorough  mastication.     The  dinner  hour  usually  follows  four  or 

1  For  additional  dietaries  see  Volume  III,  Chapter  XXVIIT. 


DIET    IN    CHILDHOOD  417 

five  hours  after  breakfast.  For  some  children  this  may  prove  too  long  an 
interval  without  food.  If  so,  a  piece  of  bread  with  an  apple  or  some  light 
food  may  be  allowed  in  the  midforenoon.  The  supper  should  be  a  light 
repast,  as  outlined  above,  and  should  be  taken^  some  two  or  three  hours 
before  retiring. 

It  will  be  admitted  that  a  diet  selected  from  the  above  list  proves 
amply  sufficient,  liberal  and  varied.  It  should  meet  all  the  requirements 
of  the  growing  body  and  even  the  special  weakness  of  the  schoolboy  or 
girl  in  the  matter  of  sweets.  Although  no  mention  is  made  of  fresh  fruit, 
this  is  to  be  regarded  as  an  essential  part  of  the  daily  diet,  for  though  its 
nutritive  value  is  not  great,  the  carbohydrate  matter,  which  is  abundant,  is 
in  a  form  which  appeals' to  the  youthful  palate.  The  action  of  fresh  fruit 
on  the  bowels  and  the  blood  renders  this  food  material  specially  desirable 
and  suitable  for  growing  boys  and  girls. 

The  medical  inspection  of  school  children  has  been  the  means  of  detect- 
ing and  remedying  many  defects  which  hamper  the  child  in  his  studies, 
and  it  may  be  safely  stated  that  a  child  who  cannot  easily  and  without 
physical  detriment  keep  up  with  his  class  is  defective,  due  to  imperfect 
vision  or  hearing,  to  sluggish  respiratory  changes  due  to  adenoids,  etc., 
to  imperfect  nutrition  at  home,  or  to  some  other  remediable  condition  that 
is  more  likely  to  be  detected  by  regular  school  inspection  than  by  the  ob- 
servation of  ignorant  and  careless  parents.  With  three  good  meals  daily 
from  the  above  dietary,  no  boy  or  girl  should  suffer  from  hunger  or  from 
failure  of  nutrition  from  lack  of  food. 

The  superintendent  of  schools  should  see  that  the  hygienic  condition 
of  the  building  is  such  as  to  favor  the  working  of  a  pupil  without  undue 
fatigue,  which  might  lessen  appetite  and  thereby  interfere  with  nutrition. 
Tasks  should  not  be  imposed  that  would  be  arduous  for  the  average  child 
to  perform,  for  the  most  part  during  school  hours.  Neither  should  the 
discipline  be  such  as  to  overtax  the  child  or  interfere  with  his  meal  hours. 

If  gTccdiness  in  partaking  of  food  is  observed  in  a  youth,  it  must  be  dis- 
couraged and  checked,  as  it  breeds  physical  ills  if  tolerated.  However, 
one  must  not  allow  a  healthy  appetite  to  remain  unsatisfied  on  the  ground 
that  moderation  is  a  desirable  virtue.  Some  parents  and  the  heads  of 
boarding  schools  consider  that  the  minimum  allowance  of  food  compatible 
with  health  is  all  that  is  desirable,  and  in  many  such  cases  children  are 
kept  in  a  chronic  state  of  starvation.  It  is  true  that  certain  children  with 
strong  constitutions,  ruddy,  rugged  and  robust,  might  stand  this  without 
ill  health  accruing,  but  there  are  instances  where  the  future  growth  and 
development  of  a  child  have  been  permanently  stunted  by  a  scanty  allow- 


418 


DIET    IN    PHYISIOLOGICAL   PERIODS 


ance  of  food.  If  at  this  period  of  growth  and  development  there  must  be 
error,  let  the  error  be  on  the  side  of  allowing  the  maximum  rather  than 
the  minimum  amount  of  food. 

DIET    DURING    PUBERTY 

The  period  of  pubescence  begins  in  the  girl  usually  about  the  thirteenth 
year  and  the  boy  about  the  fourteenth  year.  This  period  in  both  sexes  is 
marked  by  great  physical  gi'owth  and  development,  and  the  dietary,  to 
meet  these  new  demands,  should  be  rich  in  easily  digested  proteins.  There 
is  no  time  in  man's  existence  when  there  is  greater  need  for  wholesome, 
suitable,  nutritious  food — that  which  will  build  up  good  rich,  red  blood — 
than  at  this  period.  The  adolescent  should  have  liberal  allowances  of 
bread,  eggs,  meat  and  foods  of  every  kind,  provided  he  digests  them  well, 
but  highly  spiced  dishes  and  wine  should  be  tabooed. 

The  paucity  of  reliable  statistics  on  the  normal  consumption  of  food 
in  adolescence  is  a  serious  drawback  to  the  dietary  guidance  in  the  feeding 
of  young  boys  and  girls.  It  is  difficult  and  unusual  to  collect  the  basic 
facts  regarding  the  functional  needs  and  performances  in  this  period  of 
youth.  A  recent  investigation  by  Gephart(5)  gives  an  idea  of  the  actual 
amounts  of  nourishment  ingested  by  more  than  300  boys  in  one  of  the 
largest  private  boarding  schools  in  the  United  States. 

The  total  animal  supply  for  such  an  institution  containing  355  boys 
was  computed  as  follows,  in  metric  tons : 


Protein 

Fats 

Carbohydrates 

Food  supply 

20.5 
3.8 

25.6 
5.4 

60.5 

Waste.. .                         

4.2 

Food  fuel 

16.7 

20.2 

56.3 

The  quantity  of  food  computed  on  the  basis  of  the  individual  meal 
served,  appears  as  follows : 


Pounds 

Grams 

Calories 

Calories 
(Per  cent) 

Protein 

0.1107 
0.1332 
0.3717 

50.2 

60.4 

168.8 

206 
562 
692 

14' 

Fat 

39 

Carbohydrates..  . 

47 

1,460 

1  Seventy  per  cent  of  this  was  in  animal  protein. 


DIET   DURING   PUBERTY  419 

The  food  was  of  the  hest  quality,  and  inchidcd  lOlJ  separate  varieties. 
The  cost  per  meal  was  20  cents,  or  13.8  cents  per  thousand  calories.  This 
is  twice  what  the  poor  man  in  New  York  City  pays  for  his  food.  But 
these  growing  athletic  boys  were  not  satisfied  with  the  conventional  3,000 
calories  per  day.  The  investigator  of  their  dietary  ascertained  that  beside 
the  4,350  calories  which  they  consumed  daily  at  the  table,  they  bought  650 
additional  calories  in  food  at  a  neighboring  store,  the  principal  item  being 
chocolate. 

Graham  Lusk(G)  has  pointed  out  the  fact  that  the  5,000  calories  con- 
tained in  the  daily  alimentation  of  active  American  boys  of  school  age 
are  half  again  as  much  as  a  farmer  at  strenuous  work  is  thought  to  require. 
The  total  fuel  intake  of  the  boarding  school  just  mentioned  was  three 
times  that  necessary  for  the  heat  production  of  boys  from  13  to  16  years 
of  age  when  asleep  and  resting.  As  previously  emphasized,  these  findings 
serve  in  a  way  to  explain  the  ravenous  appetite  of  growing  boys  and  girls. 
Lack  of  appreciation  of  this  factor  and  lack  of  provision  for  it  are  a  fre- 
quent cause  of  much  under-nutrition  in  children. 

The  adolescent  girl  in  particular  needs  good  wholesome  rich  foods, 
more  especially  those  containing  iron.  We  have  already  called  attention 
to  the  iron  content  of  many  foods.  Lean  meat,  eggs,  and  the  dark  green 
leaves  of  vegetables,  as  spinach,  are  all  rich  in  iron.  A  well-balanced 
rational  menu  for  a  fourtoeu-y ear-old  girl  or  her  sixteen-year-old  brother 
would  Ix?  somewhat  like  the  following(7)  : 

SUITABLE   MENU   FOR    A    FOURTEEN-YEAR-OLD    GIRL    OR    HER 
SIXTEEN-YEAR-OLD    BROTHER 
Breakfast: 

Oatmeal  with  cream  and  sugar;  buttered  toast;  one  or  two  boiled  eggs;  fruit 
(grapes,  apples,  bananas,  oranges  or  berries) ;  coffee,  with  cream  and  sugar. 

Lunch: 

A  pur6c  of  cream  soup  with  crackers  or  croutons;  bread  and  butter;  fruit;  rice 
pudding  or  custard. 

Dinner: 

An  ample  portion  of  meat;  potatoes  (baked  or  boiled);  side  dish  of  vegetables; 
fruit,  stewed  or  canned,  with  graham  wafers;  bread  and  butter. 

This  dietary  is  rich  in  protein,  sufficient  to  nourish  an  adult  at  mod- 
erate work.  But  we  must  remember  that  the  adolescent  has  need  for  a 
great  excess  of  meat,  and,  as  a  matter  of  fact,  the  pubescent  boy  or  girl, 
in  school,  office  or  factory,  will  eat  quite  as  much  and  often  even  more 
than  an  adult,  and  will  be  far  more  seriously  injured  if  he  does  not  get 
the  requisite  alimentation.  If  a  boy  or  girl  craves  a  light  lunch  in  the  mid- 
afternoon,  it  should  be  allowed.    A  young  girl,  especially,  if  she  begins  to 


420  DIET   IN   PHYSIOLOGICAL   PERIODS 

show  sigus  of  pallor,  as  is  frequently  noticed  in  high  school  girls,  may  be 
directed  to  prepare  for  herself  an  egg  lemonade,  using  two  yolks  instead 
of  the  yolk  and  white  of  one  egg.  Such  a  lunch  will  not  interfere  with 
the  dinner  later  on.  The  best  stimulants  of  the  appetite  at  this  age  are 
fatigue  for  the  boy,  from  swimming,  walking  in  the  open  air,  and  moderate 
exercise  for  the  girl,  tennis  and  golf,  which  ought  to  hasten  the  return  of 
color  to  her  cheeks. 

The  craving  for  sweets  by  the  adolescent  boy  or  girl  is  a  natural  one, 
and  should  be  satisfied.  Fudge  and  other  sweets  should  be  allowed,  but 
as  a  rule  it  is  preferable  for  these  to  be  eaten  immediately  following  meal 
time.  When  partaken  of  in  this  manner  they  serve  an  important  purpose 
in  the  alimentation  and  seldom  give  rise  to  any  disturbance  of  digestion. 
As  sweets  are  the  most  condensed  sources  of  carbohydrates  and  per  volume 
are  great  sources  of  energy,  the  insatiable  desire  for  them  seems  to  be 
more  or  less  instinctive.  A  few  generations  back,  it  was  thought  and 
taught  that  the  consumption  of  sweets  had  a  tendency  to  produce  decay  of 
the  teeth,  but  at  the  present  time  the  toothbrush  brigade  has  robbed  them 
of  any  bad  reputation  which  they  have  possessed  in  this  connection. 

The  present  curriculum  in  most  high  schools  and  girls'  colleges  is 
faulty  and  could  be  greatly  improved  upon.  Long  sessions  impose  too 
long  and  severe  a  strain  on  the  boy  or  girl,  more  particularly  if  they 
happen  to  be  puny  and  with  little  or  no  desire  for  breakfast.  A  more 
sensible  plan  would  be  to  arrange  the  courses  of  instruction  so  that  no 
pupil  would  be  required  to  attend  more  than  four  consecutive  periods 
without  a  recess.  An  insufficient  breakfast,  hastily  ingested,  due  to  late 
rising-  or  to  late  hours  the  evening  before,  either  on  the  part  of  the  pupil 
or  family,  so  that  breakfast  is  not  served  in  due  time,  is  frequently  a  cause 
for  digestive  disturbances  on  the  part  of  the  pupil,  besides  furnishing  in- 
sufficient: nutrition.  The  adolescent  attending  high  school  should  have  a 
well-balanced  midday  meal,  consisting  of  good  wholesome  food.  Such  an 
arrangement  need  not  in  any  way  interfere  with  the  full  evening  dinner 
with  the  family.  Pupils  of  this  age  should  be  restrained  from  social  dissi- 
pation during  school  sessions  except  on  Friday  and  Saturday  evening. 

About  this  time  of  life  the  question  of  the  proper  allowance  of  alcohol, 
tea,  coffee  or  tobacco,  etc.,  is  one  that  will  have  to  be  met  and  answered. 
Abstinence  from  alcoholic  liquors  is  desirable  even  for  the  adult,  and 
almost  imperative  for  the  adolescent  if  health  is  to  be  maintained.  Strong 
coffee  and  tea  likewise  should  be  shunned.  Weak  cocoa  will  afford  an 
excellent  substitute  for  both. 

According  to  Benedict (8),  "It  should  be  impressed  on  the  boy  or  ^rl 


DIET    IN    ISEJDENTARY    OCCUPATIONS  421 

that  there  are  purely  physical  conditions  during  the  period  of  growth,  as 
well  as  ditferences  in  the  business  and  social  demands  upon  the  adoles- 
cent and  the  adult,  which  render  abstinence  necessary  in  the  former,  and 
indulgence  comparatively  harmless  in  the  latter.  If  the  appeal  to  judg- 
ment based  on  these  gTounds  is  not  sufficient,  parental  discipline  may  be 
necessary,  and  it  is  even  worth  considering  whether  the  health  of  the 
youth  is  not  worth  the  argument  of  example  as  well  as  precept.  The 
prejudice  against  cigarettes,  as  compared  with  stronger  forms  of  tobacco, 
is  due  almost  entirely  to  their  premature  use  by  boys  too  young  to  tolerate 
tobacco  in  other  forms." 

DIET  IN  SEDENTARY  OCCUPATIONS 

Persons  engaged  in  sedentary  occupations  which  confine  them  indoors, 
and  whose  work  is  largely  mental  rather  than  muscular,  require  a  diet 
suitable  to  their  needs  rather  tlian  one  adapted  to  the  requirements  of  a 
laborer  or  "lumber  jack."  Sedentary  workers  sooner  or  later  realize  from 
experience  that  they  must  give  attention  to  their  diet  if  they  would  remain 
in  good  health.  If  a  man  whose  vocation  does  not  permit  of  any  physical 
exercise  indulges  in  a  heavy  diet  in  which  meat  is  ingested  two  or  three 
times  a  day,  he  is  almost  certain,  sooner  or  later,  to  suffer  from  serious 
nutritional  disturbances.  First,  he  is  apt  to  put  on  an  excess  of  flesh; 
second,  his  excretory  organs,  more  especially  the  kidneys,  will  suffer  from 
the  extra  strain  in  eliminating  waste  products  of  protein  metabolism, 
with  the  result  that  at  first  he  %vill  be  annoyed  with  occasional  and  later 
almost  continuous  disabilities  of  a  rheumatic  or  a  lithemie  character; 
third,  his  digestive  organs  will  sooner  or  later  fag  under  the  burden  of 
overeating,  especially  of  foods  from  the  animal  kingdom.  As  a  result  he 
will  suffer  from  constipation,  which,  if  prolonged,  will  lead  to  an  altered 
bacterial  activity  resulting  in  auto-intestinal  intoxication  with  accompany- 
ing stasis  and  putrefaction.  The  injurious  effects  of  over-indulgence  at 
the  table  by  the  sedentary,  are  of  far-reaching  importance,  and  are  claimed 
to  be  the  chief  factor  in  the  development  of  many  serious  diseases.  There 
can  be  no  question  that  the  excessive  ingestion  of  protein  food  induces  a 
temporary  albuminuria,  similarly  glycosuria,  pentosuria,  etc.  The  great- 
est danger  from  the  excessive  ingestion  of  proteins,  and  more  especially 
animal  protein,  is  due  to  the  fact,  as  previously  pointed  out,  that  they  are 
incompletely  oxidized,  which  tends  to  the  accumulation  of  waste  products 
in  the  blood — protein  poisons  acting  injuriously  in  different  directions 
already  mentioned ;  all  of  which  may  easily  be  avoided  by  proper  alimen- 
tation. 

127 


422  DIET    m   PHYSIOLOGICAL   PERIODS 

Energy  diverted  for  mental  work  is  apt  to  be  at  the  expense  of  the 
digestive  process;  consequently,  it  is  highly  important  that  the  alimenta- 
tion should  be  closely  studied,  so  as  to  exactly  meet  the  requirements  of 
the  case,  and  not  unduly  tax  the  organs  of  digestion  nor  overwork  the 
organs  of  excretion.  As  a  rule,  meat  should  be  indvilged  in  but  once  a 
day,  and  then  only  in  moderation,  while  individuals  of  slender  physique 
and  frail  constitution  will  do  well  occasionally  to  replace  meat  by  other 
animal  foods,  as  eggs  and  fish.  Persons  engaged  in  literary  pursuits, 
writers  and  brain  workers,  often  suffer  from  lithemia,  which  in  many  cases 
is  unquestionably  due  to  other  causes  than  errors  in  diet — such  as  anxiety, 
worry  or  overwork,  "burning  the  candle  at  both  ends."  This  class  of 
patients  do  better  on  a  full  diet  of  good,  wholesome,  well-cooked  food, 
which  is  nourishing,  light  and  digestible.  They  should  be  instructed  to 
avoid  fatty  and  purely  starchy  dishes,  but  they  need  meat,  and  it  may  be 
allowed  in  moderate  amount.  Variety  in  fruits  and  fresh  green  vegetables 
is  also  desirable.  The  following  aliments  should  be  rigidly  restricted : 
rich  gravies,  sauces,  custards,  patties,  lean  meat  in  made  dishes,  pastry, 
highly  seasoned  or  fried  entrees.  The  menu  for  the  sedentary,  whether 
professional,  literary  or  business  man,  should  be  somewhat  as  follows 
(Hall)  : 

SUITABLE  DIETARY  FOR  THE  SEDENTARY 

Breakfast: 

Fruits,  preferably  a  baked  apple;  breakfast  bacon;  buttered  toast;  muffins  or 
gems;  coffee  with  cream  and  sugar. 

Lunch: 

A  cream  soup  or  pur^e  with  crackers,  or  sandwich  and  fruit,  with  a  cup  custard. 
Dinner: 

Meat,  white  bread,  potatoes;  vegetables;  salad;  fruit;  a  light,  easily  digestible 
pudding,  such  as  rice,  chocolate,  or  bread  pudding  with  fruit  sauce;  gelatin  or 
tapioca  with  fruit;  coffee  or  tea  with  cream  and  sugar. 

By  some  this  dinner  may  be  thought  to  be  rather  heavy,  but  we  will 
assume  that  the  sedentary  gentleman  will  partake  of  the  different  courses 
rather  sparingly ;  that  he  will  linger  long  at  the  table  in  a  social  hour  with 
the  family  in  regular  deipnosophistic  fashion,  vrith  quip  and  repartee, 
keeping  the  whole  dinner  circle  in  good  spirits,  which  will  give  him  suf- 
ficient time  to  thoroughly  masticate  his  food. 

The  brain  tissue  is  composed  very  largely  of  fat — three  times  as  much 
as  in  muscular  tissue,  while  the  nerves  contain  an  even  greater  percentage. 
!N'on-lithemic  brain  workers  may  advantageously  partake  of  fats  and  car- 
bohydrates— foods  which  may  be  supplied  in  the  form  of  cream,  butter 


DIET    m    SEDENTARY    OCCUPATIONS 


423 


and  well-cooked  bacon,  bread,  potatoes  and  vegetables.  The  reason  that 
some  writers  laud  fat  as  a  food  for  brain  workers  is  the  ease  with  which 
it  is  metabolized  into  energy.  The  popular  idea  that  fish,  owing  to  the 
large  percentage  of  phosphorus  contained  in  it,  possesses  some  specific 
action  as  a  brain  food  is  now  an  exploded  theory.  Fresh  fish  is,  however, 
very  wholesome,  and  by  replacing  meat  in  the  menu  is  more  easily  metab- 
olized by  the  digestive  organs.  The  sedentary  brain  worker  who  desires 
to  keep  in  a  fit  condition  should  have  a  light  lunch  and  dine  late  in  the 
day.  It  is  desirable  during  the  active  hours  of  close  mental  application 
to  supply  only  the  food  actually  necessary  for  the  prompt  production  of 
the  requisite  energy  without  borrowing,  so  to  speak,  or  drawing  upon  the 
digestive  organs  for  the  expenditure  of  energy  in  elaborating  food  which  is 
only  needed  for  storage. 

A  tour  of  inspection  of  the  downtown  metropolitan  district  of  any 
large  city  at  the  noon  lunch,  hour  reveals  two  sharply-defined  classes  of 
patrons:  (a)  Those  who  believe  in  steaks  and  chops  as  the  best  brain  and 
nerve  food,  and  with  whom  economy  is  of  no  moment,  and  who  spend  a 
dollar  or  a  dollar  and  a  half  for  luncheon;  (&)  those  who  believe  in  stay- 
ing the  pangs  of  hunger  for  the  least  money.  Members  of  this  class  spend 
ten  cents  for  a  piece  of  pie  and  some  cheese  and  five  cents  more  for  a  cup 
of  coffee  or  a  glass  of  milk,  and  get  just  as  much  fuel  value  or  force  and 
energy  as  the  former — provided,  of  course,  the  ingested  food  is  assimi- 
lated. 

COMPARATIVE  LUNCHES 


Proteins 

Fat 

Carbo- 
hydrates 

Calories 

(a)  Chops.           

15     grams 

2.1       « 

.5       " 

20     grams 

.1       « 

1.6       « 

17.7  grams 

1.4       « 
12 

247.5 

Potatoes 

82 

Salad 

23 

Orange  ice 

49 

17.6  grams 

21.7  grams 

31.1  grams 

401.5 

(6)  Mince  pie  (slice) 

}/2  oz.  cheese 

6     grams 
3.5       « 
8.3       « 

15     grams 
4.1 
10 

66     grams 
0.3       " 
12.5       " 

436 
53.7 

3^  pt.  milk 

178 

17.8  grams 

29.1  grams 

78.8  grams 

668.7 

Mrs.  E.  H.  Richards (9)  has  worked  out  a  daily  ration  for  the  seden- 
tary business  man,  professional  man  or  literary  worker,  but  in  our 
opinion,  the  protein  allowance  is  entirely  too  liberal.  We  give  the  table 
below : 


424  DIET    IX    PHYSIOLOGICAL   PERIODS 

RICHARDS'  RATION  FOR  SEDENTARY  OCCUPATIONS 


Food 


Amount 


Proteins 


Fats 


Carbo- 
hydrates 


Calories 


Bread 

Meat 

Butter 

Sugar 

Milk 

Oysters 

Soup 

Potatoes 

Eggs 

Oatmeal 

Cream 

Fruit. 

Additional     liquid  —  tea, 
coffee  or  water 

Total 


16  oz. 

16  « 

1  « 
4  " 
8  « 
4  « 
4  " 
6  " 
3  " 

2  " 
1  " 


30   " 


32.0  grams 
50.0     " 


18.0  grams 

7.0  " 

4.0  " 

3.0  « 

10.0  " 

1.0  « 

1.5  " 

0.5  " 


3.0  grams 
30.0    "" 
25.0      « 

18.0gramts 
1.0      « 
3.0     « 

9.0  grams 
0.5      " 
6.5      " 


258.0  grams 


110.0  grams 
22.0     " 


38.0  grams 

4.0  grams 
1.0     " 
50.0      " 


1,216.6 

481.0 

230.0 

451.0 

329.6 

37.8 

44.0 

168.1 

123.8 

25.1 

70.1 

207.1 


77  oz. 


127.0  grams 


96.0  grams 


483.0  grams 


3,384.2 


Contented  should  be  the  man  whose  digestive  organs  are  functionating 
normally,  who  is  so  well  balanced  that  he  takes  his  breakfast,  as  his  news- 
paper, as  a  matter  of  course,  and  who  is  no  more  perturbed  by  the  fraction 
of  variation  in  the  stiffness  of  his  boiled  egg  than  by  the  rumor  of  an  out- 
burst of  Mt.  Vesuvius.  Happy  is  he  who  sits  down  to  the  dinner  provided 
for  him  without  thought  of  what  he  must  partake  of  and  what  he  must 
not,  with  a  mind  free  for  social  pleasure,  secure  in  the  skill  and  exercise 
in  the  culinary  department  of  his  household.  Who  would  not  strive  to 
have  this  feeling  of  self-assurance  ?  And  yet  how  few  are  willing  to  pay 
the  price !  A  little  thought,  a  little  self-control,  and  then  forget  that  there 
is  such  a  thing  as  digestion.  Blessed  be  the  man  whose  organs — and  espe- 
cially the  organs  of  digestion — are  functionating  normally  and  properly 
without  his  being  conscious  of  it.     Only  in  such  cases  is  he  a  whole  man. 

Overeating  should  be  religiously  avoided  by  the  sedentary  individual. 
We  have  already  emphasized  this  point  (Volume  II,  Chapter  VI),  but 
again  we  caution  against  overloading  the  system  with  incompletely  as- 
similated foods  which  obtund  intellectual  activity  and  lead  to  exhaustion 
of  the  nen^ous  system.  If  some  arduous  task  requiring  long  hours  and 
absorbing  concentration  and  painstaking  care  is  imposed,  it  will  be  better 
to  take  two  light  lunches  during  the  day.  If  the  task  proves  fatiguing,  a 
little  Burgundy  or  white  wine  may  be  taken  with  the  lunch.  It  may, 
according  to  Chambers,  "stay  the  weariness  of  the  system  and  allow  the 
nerve  force  to  be  diverted  to  the  digestion  of  the  meal,  but  to  labor  on  and 


DIET    DUEIA^G    MENSTRUATION  425 

continue  to  take  tliis  anesthetic  between  meals  is  inconsistent,"  and  ''when 
extraordinary  mental  toil  is  temporarily  imposed,  extreme  temperance  or 
even  total  abstinence  should  be  the  rule,  for  mental  activity  makes  the 
brain  bear  less  alcohol  than  rest  and  relaxation." 

The  sedentary  person  who  remains  much  indoors  should  have  frequent 
week-end  outings  of  two  or  three  days  when  all  the  cobwebs  may  be  blown 
away  and  all  his  arterioles  flushed  out  with  ozone  from  the  ocean  breezes 
or  mountain  blasts.  The  stimulus  of  change,  even  if  the  food  is  only  mod- 
erately good,  is  invaluable. 

DIET    DURING    MENSTRUATION 

A  perfectly  well  woman  whose  menstrual  periods  recur  with  clock- 
like precision  need  not  be  treated  as  an  invalid  during  menstruation,  and 
her  alimentation  need  not  be  other  than  usual.  Of  course  it  is  understood 
that  during  the  catamenial  period  she  should  avoid  very  cold  or  very  hot 
baths,  and  should  also  shun  excessive  physical  exertion  or  severe  mental 
strain. 

Absence  of  the  menstrual  function  is  a  frequent  accompaniment  of 
mental  disturbance  due  to  great  grief,  fright  or  anxiety,  while  an  exces- 
sive development  of  fat  may  prevent  the  flow  appearing  even  in  persons 
whose  general  health  appears  to  be  excellent.  Here  proper  dieting  will 
be  beneficial.  Menstruation  may  be  absent  without  causing  the  slightest 
inconvenience  or  perturbation ;  on  the  other  hand,  there  may  be  present, 
coincident  with  the  menstrual  period,  a  feeling  of  general  disturbance 
accompanied  by  headache,  flashes  of  heat,  nervousness,  nausea  and 
vomiting,  due  largely,  if  not  altogether,  to  a  run-down  condition  of  health, 
both  mental  and  physical,  which  appropriate,  wholesome,  nutritious, 
nitrogenous  diet  will  gi*eatly  benefit. 

Various  menstrual  disturbances  may  be  expected  in  a  certain  percent- 
age of  young  girls,  especially  during  the  first  year  or  two  following  the 
appearance  of  the  catamenia,  which  indicate  rest,  confinement  to  the  room 
or  to  bed,  and  a  dietary  corresponding  to  the  physical  condition  of  the 
patient,  and  to  her  relative  quiescence  and  environment  Anemia, 
chlorosis  and  thyroid  disturbances  depending  on  menstruation  will  receive 
attention  elsewhere. 

DIET    DURING    PREGNANCY 

A  good,  simple,  well-balanced  dietary  is  best  adapted  for  the  normal 
pregnant  woman,  and  unless  complications  arise  it  is  not  customary  to 
direct  any  definite  system  of  alimentation. 


426  DIET    IlSr    PHYSIOLOGICAL    PEEIODS 

As  soon  as  pregnancy  is  positively  determined,  the  hygienic  and 
dietetic  care  of  the  woman  should  be  outlined.  First,  she  should  take  daily 
the  requisite  amount  of  exercise  in  the  open  air;  second,  too  much  im- 
portance cannot  be  laid  upon  the  necessity  of  preventing  constipation; 
third,  her  alimentation  should  be  regulated  to  fit  her  requirements  and 
environment;  fourth,  gastric  disturbances,  usually  termed  "morning  sick- 
ness," which  may  or  may  not  be  a  harassing  symptom,  must  receive  atten- 
tion. If  serious  vomiting  occurs  in  the  early  months,  the  most  careful  and 
painstaking  attention  should  be  given  the  dietary.  The  first  principle  in 
the  dietetic  treatment  of  vomiting,  according  to  Watson,  is  to  give  the 
stomach  a  rest.  Then  the  dietetic  substances  usually  prescribed  for  the 
relief  of  nausea  and  vomiting  and  for  nourishment  are  indicated,  among 
which  may  be  suggested  cracked  ice ;  pancreatized  milk,  milk  with  sodium 
bicarbonate  (ten  grains)  ;  milk  and  lime  water,  milk  and  vichy,  soda, 
seltzer,  or  carbonic  acid  water ;  whey  and  kumiss ;  beef  extracts  and  pepto- 
noids;  raw  meat  juice;  raw  meat  pulp;  scraped  meat;  clam  broth;  dry 
toast,  etc. 

The  "longings"  of  pregnant  women  for  various  indigestible  articles, 
such  as  dill  pickles,  etc.,  so  far  as  they  are  kept  within  reasonable  bounds, 
may  be  gratified,  but  there  seems  to  be  no  reasonable  evidence  that  the 
refusal  to  satisfy  such  caprices  has  any  effect  upon  the  physical  or  mental 
development  of  the  child.  These  "longings"  are  largely  mythical  and 
occur,  if  at  all,  only  as  an  accompaniment  of  a  general  hysterical  condition, 
and  not  as  a  peculiarity  of  the  period  of  pregnancy. 

Albuminuria  and  dropsy  are  serious  symptoms  complicating  pregnancy, 
and  their  presence  demands  the  most  careful  attention  to  the  dietary. 
In  these  complications  the  lightest  possible  diet  should  be  outlined,  throw- 
ing the  least  strain  upon  the  kidneys  and  other  glandular  organs.  In  very 
severe  cases  it  may  be  necessary  to  prescribe  an  exclusive  milk  diet ;  in  less 
severe  cases  a  diet  of  milk,  bread,  farinaceous  foods,  and  simple  fruits 
may  suffice ;  while  in  the  milder  forms  of  derangement  all  that  is  necessary 
will  be  to  avoid  red  meats  and  richer  dishes  of  all  kinds  and  subsist  on  the 
lacto-vegetarian  diet  described  in  Volume  II,  Chapter  XV. 

The  quantity  of  food  during  pregnancy  should  not  exceed  what  is 
usually  required  by  a  healthy  woman,  the  meals  should  be  taken  at  regular 
intervals,  and  those  articles  of  food  known  to  disagree  should  be  avoided. 
The  diet  throughout  the  period  of  gestation  should  be  simple  and  whole- 
some but  varied.  Tea,  coffee  and  alcoholic  beverages  should  be  allowed 
with  caution.  The  vulnerability  of  the  liver  raises  the  question  of  doubt 
as  to  whether  ale,  beer  or  stout  should  be  permitted.     Large  amounts  of 


DIET    DURING    PREGNANCY  427 

meat — more  particularly  canned  meat,  canned  vegetables,  sea  food  at  a  dis- 
tance from  the  ocean,  undrawn  poultry  and  stale  eggs,  in  which  decompo- 
sition may  have  already  begim,  should  be  avoided  also,  as  should  liver, 
tliymus  and  kidney  on  account  of  extractive  waste  and  excessive  amounts 
of  purins.  Animal  foods,  even  when  sparingly  taken,  force  the  already 
congested  liver  to  supplementary  work  in  eliminating  toxins  arising  from 
muscular  tissue,  and  should  be  entirely  stopped  if  even  traces  of  albumin 
appear  in  the  urine.  Milk  should  be  discontinued  altogether  if  there  are 
any  symptoms  of  eclampsia.  In  general,  however,  cereals,  milk,  cream 
and  butter,  fresh  eggs,  small  amounts  of  fresh  meat — especially  poultry 
and  fresh  fish,  fresh  (pod)  vegetables,  sweet  and  white  potatoes  and  other 
vegetables  rich  in  nutriment  and  with  only  a  small  percentage  of  indiges- 
tible residue,  and  fresh  fruits,  omitting  strawberries,  blackberries,  blue- 
berries, etc.,  should  be  the  mainstays  of  the  pregnant  woman's  dietary. 

The  idea,  formerly  prevalent  among  the  laity  and  to  some  extent  among 
medical  men,  that  pregnant  women  should  partake  largely  of  foods  con- 
taining abundant  phosphates  and  lime  salts  to  furnish  the  embryo  with 
material  for  the  production  of  bone,  is  now  an  exploded  theory,  since  the 
organic  ^alts  in  question  are  plentifully  supplied  in  an  ordinary  mixed 
diet. 

Another  fallacious  theory,  equally  as  ingenious,  though  directly  op- 
posed to  the  foregoing,  is  interesting  only  historically.  It  was  once  claimed 
that  the  agonies  of  labor  would  be  less  severe  if  the  pregnant  woman  lived 
upon  a  diet  composed  largely  of  fruits  and  meat,  avoiding  fresh  vegetables, 
on  the  assumption  that  the  lime  salts  contained  in  them  would  favor  early 
ossification  of  the  infant's  skeleton  and  thus  add  to  the  difiiculties  of  par- 
turition. It  is  so  well  known  that  Nature  is  abundantly  competent  to 
regulate  this  process  unaided  that  this  theory,  like  the  first,  is  no  longer 
accepted.  However,  the  size  of  the  child  can  be,  to  some  extent,  regulated 
by  diet.  The  trend  of  modern  thought,  experience,  and  to  a  certain  extent, 
scientific  research,  according  to  Watson (2),  tend  to  show  that  scientific 
alimentation  can  influence  material  and  fetal  tissues  in  such  a  way  as  to 
make  labor  more  easy  and  to  increase  the  chances  for  a  viable  child  being 
born.  This  is  of  special  moment  to  the  physician  who  has  under  his  care 
a  woman  with  a  small  or  contracted  pelvis  w^ho  has,  in  consequence  of  the 
dangers  associated  with  labor  under  these  anatomic  conditions,  given  birth 
to  one  or  more  still-born  children. 

Watson  records  the  claims  of  Proohownick(lO)  and  other  investigators 
who  prescribe  a  diet  deficient  in  carbohydrates  and  fluids  that  result  in  a 
small  child  which,  in  every  other  particular,  is  well  developed.     The 


428  DIET    I:N^   PHYSIOLOGICAL    PEKIODS 

claims  of  Prochownick  are  that  with  a  conjugate  diameter  of  8  cm.  a  diffi- 
cult labor  can  be  obviated  and  the  induction  of  premature  labor  rendered 
unnecessary.  He  suggests  that  the  following  dietary  should  be  prescribed, 
beginning  from  ten  to  twelve  weeks  before  labor  is  expected,  and  rigidly 
adhered  to,  more  particularly  during  the  last  two  months  of  parturition: 

PROCHOWNICK'S  ORIGINAL  DIET 

Breakfast: 

Small  cup  of  coffee,  3  ounces;  breadstuff,  1  ounce,  with  a  little  butter. 
Dinner: 

Meat,  eggs,  or  fish,  with  a  little  sauce;  green  vegetables,  prepared  with  cream; 
salad;  cheese. 
Supper: 

Much  as  dinner — 1  to  13^  ounces  of  bread  with  butter  (water,  soups,  potatoes, 
sugar,  and  beer  are  strictly  withheld). 
This  average  diet  consists  of: 

Protein 140  to  160  grams 

Fat 80  to  130      « 

Carbohydrates 100  to  110      « 

Fluids,  about 500  c.c.  daily 

Altogether  a  fuel  value  of 1800  to  2000  calories 

According  to  Watson,  polydipsia  is  complained  of  during  the  first  few 
days  of  this  dietetic  regimen,  but  it  soon  passes  off.  He  also  records  that 
some  patients  complain  of  the  large  amount  of  animal  food. 

"All  the  confinements  reported  were  much  easier  than  on  former  occa- 
sions, even  when  the  child  was  large  and  fat.  All  the  children  were  born 
alive.  The  children  were  usually  lean  at  birth,  with  the  bones  of  the  head 
unusually  mobile.  They  were  apparently  mature  in  every  way,  and  in  the 
majority  of  cases  the  child  gained  normally  after  birth,  and  the  diet  had 
apparently  exercised  no  injurious  effect  whatever  on  the  child,  or  on  the 
mother  during  pregnancy  or  the  period  of  lactation.  On  such  a  diet,  it  is 
essential  that  the  condition  of  the  urine  should  be  carefully  observed,  the 
amount  of  urea  and  the  presence  or  absence  of  albumin  in  the  urine  being 
specially  noted.  Unlike  what  might  have  been  expected,  it  was  found 
that  this  diet  did  not  apparently  favor  the  onset  of  eclampsia."  In  the 
majority  of  instances  it  has  been  observed  that  the  child  thrived  normally 
after  birth,  and  the  diet  had  no  bad  effects  on  lactation. 

DIET    DURING    THE    PUERPERIUM 

The  dietary  of  the  puerperal  woman  has  undergone  a  revolution  dur- 
ing the  past  few  decades.  She  is  no  longer  kept  for  ten  days  upon  a  diet 
of  toast,  weak  teas  and  other  "slops,"  with  the  idea  that  semistarvation 
would  lessen  the  chances  of  puerperal  fever  and  "milk  fever."  These 
changes  are  largely  due  to  modern  obstetric  teaching,  and  to  the  applica- 


DIET    DURING    LACTATION  429 

tion  of  antiseptic  and  aseptic  precautions  during  labor.  Immediately  after 
delivery,  a  woman  may  be  allowed  a  cup  of  warm  tea  or  warm  milk. 
Later  she  may  be  fed  milk,  soft-boiled  eggs  and  dry.  buttered  toast ;  the 
next  few  days  bread,  milk,  soup,  chops  or  steaks  in  limited  quantities. 
She  can  then  gradually  return  to  the  diet  which  she  naturally  prefers, 
avoiding,  of  course,  indigestible  dishes,  as  cabbage,  fried  foods,  seed 
vegetables  and,  above  all,  dried  beans  and  other  legumes. 

Immediately  after  a  prolonged  labor  the  woman  is  left  so  exhausted 
by  excessive  muscular  effort  and  agonizing  pain  that  she  is  too  tired  to 
eat,  and  is  more  thirsty  than  hungry,  so  she  may  have  a  glass  of  milk  and 
vichy  at  this  time.  As  many  of  the  complications  of  labor,  as  mania,  are 
favored  by  exhaustion  and  inanition,  a  sustaining  and  stimulating  diet  is 
of  the  greatest  importance.  The  nursing  woman,  moreover,  requires 
a  more  liberal  diet  than  other  patients,  as  her  mammary  excretion,  to 
furnish  the  requisite  food  for  the  child,  must  contain  a  large  percentage  of 
protein  and  fat,  and,  since  she  is  constantly  losing  a  protein  substance  in 
the  lochia,  she  must  be  full  fed  or  her  milk  will  be  poor  and  insufficient. 
It  is  a  bad  practice  to  allow  a  healthy  lying-in  woman  to  fast  too  long. 
She  needs  to  be  well  and  full  fed  and  will  sleep  better  and  feel  better 
than  if  she  receives  too  little  food.  While  the  patient's  own  appetite  is  a 
better  guide  for  feeding  than  any  hard  and  fast  rule  that  may  be  formu- 
lated, she  should  be  urged  to  take  food  unless  greatly  exhausted,  but  care 
must  be  exercised  not  to  overload  the  stomach.  After  the  milk  secretion 
has  been  established  and  the  bowels  regulated,  she  may  bo  allowed  a  rea- 
sonable quantity  and  variety  of  food,  though  while  in  bed  she  requires 
less  than  later  when  up  and  about.  Any  complication  with  a  rise  in  tem- 
perature is  a  contra-indication  for  allowing  much  animal  fclpd,  except 
milk,  but  extreme  exhaustion  without  febrile  action  demands  it 


DIET    DURING    LACTATION 

The  period  of  lactation  usually  lasts  for  about  one  year,  though  towards 
the  end  of  the  seventh  or  eighth  month  the  quality  and  quantity  of  the 
milk  secreted  begin  to  fall  off.  Some  mothers  nurse  their  children  far  into 
the  second  year,  but  the  nutritive  properties  of  the  milk  are,  of  necessity, 
very  poor. 

The  diet  of  the  nursing  mother  must  be  regulated  to  prevent  noxious 
substances  from  passing  into  the  breast  milk  and  to  keep  her  in  the  best 
possible  condition  of  health,  so  that  she  does  not  suffer  from  digestive 
disturbances.    Edgar  says(ll):  "If  milk  is  readily  assimilated  and  does 


430  DIET    IN    PHYSIOLOGICAL    PERIODS 

not  tend  to  constipation,  she  may  drink  it  abundantly.  She  may  also  be 
allowed  gruels,  meat  broths,  meat,  eggs,  vegetables,  and  other  simple  nour- 
ishing food.  Fruits,  even  if  acrid,  are  not  objectionable  if  they  do  not 
react  unfavorably  through  the  breast  milk  upon  the  child,  and  if  the 
mother's  digestion  is  good  they  serve  to  keep  the  child's  bowels  active.  A 
nursing  woman  should  be  given  meat  as  lamb  chops,  beef  and  bacon — 
fish,  beans,  etc.  A  reasonable  amount  of  fatty  foods  in  all  forms  if  they 
are  well  digested,  and  cheese,  potatoes,  bread,  rice,  green  and  dry  peas  and 
lentils,  which  excite  mammary  secretion  (but  not  dry  haricot  beans). 
Green  vegetables  are  also  allowable,  with  the  exception  of  cabbage,  cress, 
garlic,  leaks,  onions,  mushrooms,  salads  and  sorrel,  which  permit  noxious 
substances  to  pass  into  the  mammary  secretion.  Rich  and  indigestible 
foods  and  alcoholic  drinks,  beyond  a  glass  of  white  wine  and  a  pint  of  beer 
or  cider,  should  be  avoided."  While  malt  liquors  sometimes  cause  an  in- 
creased secretion  of  milk,  this  is  because  more  fluid  is  drunk  and  is  not 
due  to  any  specific  action  of  the  drink,  and  the  breast  milk  is  not  improved. 
A  reasonable  quantity  of  fluids  is  beneficial  and  is  necessary  to  maintain 
the  mammary  secretion,  but  milk  broths,  soups  and  plain  vichy  water  are 
far  preferable  to  beer,  ale  or  porter.  Weak  tea  and  coffee  in  small  quan- 
tities are  not  objectionable  if  the  mother  craves  them.  As  already  stated, 
a  nursing  woman  should  be  full  fed,  but  not  "stall  fed,"  that  is,  to  excess. 
Her  daily  alimentation  should  furnish  her  with : 

Protein 150  grams  600  calories 

Fat 100      "  900 

Carbohydrates 500      «  2000 

Total 3500       « 

Below  is  given  an  allowance  for  one  day's  ration  as  calculated  by 
Gautier  (12).  The  weight  of  the  constituent  alimentary  principles  of  the 
allowance  is  as  follows : 

A  DAY'S  RATION  FOR  A  NURSING  WOMAN 


Kinds  of  Food 

Weight 

Protein 

Fat 

Carbo- 
hydrates 

Bread 

600  grams 
400      « 
100      « 
150      " 
65      « 

50     grams 

80 

23 

2.4      " 

0 

7 

5.1  grams 
28         «   ■ 

2 

0.5      « 
60 

0 

300  grams 

2      « 

Meat 

Beans,  peas,  lentils 

59      " 

Potatoes 

30      " 

Butter 

0      " 

Beer,  \\4  pt 

20      " 

1,315  grams 

162.4  grams 

95.6  grams 

411  grams 

DIET    DURING    LACTATION  431 

This  ration  will  funiisli  fuel  energy  to  the  extent  of  3,150  calories. 
The  beer  may  be  replaced  with  a  pint  of  milk,  and  the  meat  may  be 
reduced  and  eggs  and  fresh  vegetables  substituted.  After  all  has  been  said, 
the  best  galactagogue  is  good,  nourishing,  wholesome,  simple  food,  espe- 
cially rich  cow's  milk,  not  so  much  because  it  is  milk,  but  because,  on  the 
whole,  it  is  easily  digested  and  readily  assimilated  and  furnishes  approxi- 
mately the  right  proportion  of  solids  and  water  needed  in  the  secretion 
of  the  mother's  milk.  Benedict  advises  withholding  all  drugs  during 
lactation,  more  especially  laxatives,  iodids,  mercury,  etc.,  unless  there  is 
si)ecial  indication  to  medicate  the  child.  In  cases  where  opium,  alkaloids, 
atropin,  bromids  or  any  "strong"  medicines  which  act  directly  upon  the 
nervous  system,  must  be  given,  nursing  should  be  suspended,  and  the  child 
fed  artificially  for  the  time.  The  breasts,  in  the  interval,  should  be  evacu- 
ated by  means  of  the  breast  pump,  and  a  twenty-four  or  forty-eight  hour 
interval  should  elapse  after  medication  is  suspended.  Foods  which  con- 
tain volatile  substances,  onions,  garlic,  or  hypnotic  substances,  such  as  let- 
tuce, hops  or  beer,  or  meats  or  fowl  that  is  "high,"  should  not  be  per- 
mitted. 

To  a  limited  extent  the  quantity  of  the  mammary  secretion  can  be 
increased  by  the  allowance  of  liquid  foods  and  more  water  than  is  habitu- 
ally taken.  On  the  other  hand,  it  can  be  reduced  by  withholding  water, 
or  by  withdrawing  serum  from  the  blood,  as,  for  instance,  by  purgation. 
The  ingestion  of  more  carbohydrates  and  hydrocarbons  does  not  modify 
the  milk,  b\it  an  abundant  consumption  of  proteins  increases  the  percentage 
of  fat,  which  is  the  only  ingredient  of  milk  that  can  be  influenced  by  diet. 
The  protein  content  can  be  lessened  to  some  extent  if  the  mother  is  en- 
gaged in  any  occupation  which  calls  for  strenuous  daily  exercise  to  the 
point  of  moderate  weariness. 

The  influence  of  diet  and  exercise  upon  the  secretion  of  the  mammary 
glands  has  led  E,otch(13)  to  formulate  the  following  rules: 

To  increase  the  total  quantity  of  milk:  (a)  Increase  proportionately 
the  amount  of  liquids  in  the  mother's  diet;  and  (h)  encourage  her  to  be- 
lieve that  she  can  nurse  her  infant. 

To  decrease  the  total  quantity:  Decrease  proportionately  the  amount 
of  liquids  in  the  mother's  diet. 

To  increase  the  total  solids:  (a)  Shorten  the  nursing  intervals;  (h) 
decrease  the  mother's  exercise;  (c)  decrease  the  proportion  of  liquids  in 
her  diet. 

To  decrease  the  total  solids:  (a)  Prolong  the  nursing  intervals;  (&) 


432  DIET    IX    PHYSIOLOGICAL    PERIODS 

iucrease  the  mother's  exercise ;  (c)  increase  the  proportion  of  liquids  in  her 
diet. 

To  increase  the  fat :  Increase  the  proportion  of  meat  in  her  diet. 

To  decrease  the  fat :  Decrease  the  proportion  of  meat. 

To  decrease  the  proteins :  Increase  exercise  up  to  the  limit  of  fatigue. 

A  nursing  mother  should  cancel  social  obligations  so  as  not  to  interfere 
with  the  nutrition  of  her  child,  and  all  excessive  physical  strain  and  ex- 
citement are  to  be  avoided.  No  engagements  which  conflict  with  the  regu- 
lar times  of  nursing  should  be  made,  and  only  the  most  pressing  demands . 
for  recreation  or  important  business  transactions  should  excuse  the  nursing 
of  an  infant  in  public  places. 

DIET    DURING    THE    MENOPAUSE 

The  menopause  climacteric,  or  "change  of  life,"  in  females  is  attended 
by  marked  disturbances  of  the  nervous  system,  the  precise  nature  of  which 
is  not  thoroughly  understood,  but  which  are  beyond  doubt  influenced  by 
the  functions  of  the  ovaries.  The  reproductive  organs  are  undergoing  a 
complete  change.  The  caliber  of  the  vessels  is  shrinking,  the  blood  supply 
is  lessened,  and  atrophy  of  the  ovaries,  tubes  and  uterus  is  slowly  taking 
place ;  even  the  breasts  become  flat  and  shriveled,  and  other  parts  lose  the 
form  and  appearance  characteristic  of  the  reproductive  period  (14). 

The  menopause(15)  occupies  about  five  years — two  or  three  from  the 
commencement  of  irregularity  to  the  cessation  of  the  menstrual  function, 
and  a  similar  period  during  which  time  involution  becomes  complete  and 
the  normal  activity  of  the  body  is  established. 

An  important  point  in  the  management  of  women  at  this  period  of 
their  lives  is  to  forcibly  impress  upon  them  the  fact  that  they  have  no 
definite  disorder,  but  are  merely  undergoing  a  perfectly  normal  physio- 
logical cessation  of  a  function (8),  and  that,  while  they  are  likely  to  be 
annoyed  with  various  manifestations  of  physical  and  psychic  disturbances, 
they  will  in  all  probability  pass  through  the  "change"  without  serious 
consequences.  Even  in  a  normal  menopause  a  multitude  of  s\Tnptom8  may 
be  present,  such  as  headache,  trembling,  flashes  of  heat,  palpitation  and 
shortness  of  breath,  insomnia,  nervousness,  irritability,  nervous  depression 
and  "nagging."  During  its  course  all  physiological  functions  are  weak- 
ened, and  all  pathological  conditions  aggravated (16).  If,  however,  a 
woman  presents  a  train  of  svmptoms  indicating  distinct  pathological 
changes,  she  should  be  examined  and  treated  appropriately. 

There  is  usually  a  marked  derangement  of  the  nervous  system  at  this 


DIET    IN    OLD    AGE  433 

period,  in  some  instances  even  affecting  the  mentality  of  the  patient.  The 
patient  may  present  slight  vagaries,  a  loss  of  interest  in  the  affairs  of  life, 
and  in  extreme  cases  melancholia  or  other  forms  of  a  loss  of  mental  bal- 
ance may  be  observed.  During  the  "change"  the  excretions  and  secretions 
should  be  watched ;  the  nutrition  should  be  carefully  looked  after ;  waste 
and  repair  should  balance ;'  dietetic  excesses  and  irregularities  should  be 
avoided,  and  care  should  be  exercised  in  the  preparation  and  serving  of 
meals  so  as  to  appeal  to  the  five  senses.  The  diet  should  be  simple,  un- 
irritating  and  easily  digested  and  assimilated.  Meats  should  be  restricted 
and  fresh  vegetables  liberally  consumed.  As  sugar  is  apt  to  set  up  fermen- 
tation in  the  stomach,  candies,  preserves,  jellies  and  sweet  puddings  are  to 
be  taken  in  moderation.  Pastry,  hot  breads,  fried  foods  and  rich  dishes 
nnist  be  interdicted.  The  patient  should  imbibe  freely  of  good  spring 
water,  drinking  three  or  four  pints  daily.  Stimulants  are  to  be  taken  very 
sparingly  and  alcohol  in  any  form  is  prohibited.  The  patient  should  lead 
a  regular  and  careful  life,  taking  gentle  exercise  in  the  open  air.  She 
should  be  kept  as  free  from  worry,  anxiety  and  mental  strain  as  possible, 
should  be  instructed  to  rest  in  bed  during  the  menstrual  period,  and  to 
observe  early  hours,  bathe  regularly  and  keep  the  skin  and  bowels  active. 
It  must  not  be  overlooked  that  certain  diseases  have  a  predilection  for 
development  at  the  menopause,  such  as  thyroid  disturbances,  diabetes, 
hepatic  and  renal  degenerations.  The  use  of  ovarian  extracts,  after  or 
(during  the  climacteric,  is  now  thought  to  be  of  doubtful  propriety,  yet 
^ome  clinicians  claim  good  results  from  the  administration  of  corpus 
luteum  products.  If  the  health  is  carefully  looked  after  during  this  period, 
tjie  pathological  conditions  will  subside,  but,  according  to  Tibbles(15), 
''Xogligence  and  disregard  of  the  physician's  advice  may  result  in  a  serious 
breakdown  from  nervous  or  other  causes,  and  may  lead  to  permanent  im- 
pairment of  the  health.  Due  care  as  to  the  alimentation,  proper  attention 
to  the  fimctions  of  the  skin,  kidneys  and  bowels,  a  careful  mode  of  life, 
proper  rest  and  freedom  from  worry  and  excitement,  will  lead  to  the  re- 
establishment  of  health  and  formation  of  mens  sa/na  in  corpore  sano,'* 

DIET    IN    OLD    AGE 

Before  discussing  the  question  of  diet  in  old  age,  it  may  be  well  to 
attempt  a  definition  of  old  aga  By  no  means  can  this  be  reckoned  by  the 
number  of  years  a  man  or  woman  has  attained.  There  are  old  young  men 
and  young  old  men.  Premature  senility  overtakes  some  individuals,  gen- 
erally of  the  male  sex,  at  middle  age  or  even  before,  while,  on  the  other 


434  DIET    IN    PHYSIOLOGICAL   PEKIODS 

hand,  there  are  men  old  in  years  who  retain  the  physical  and  mental  char- 
acteristics of  healthy  middle  age.  What  then  constitutes  old  age  ?  What 
are  the  physical  and  physiological  criteria  that  go  to  mark  the  failing  of 
the  bodily  powers  ?  For  in  the  case  of  premature  senility  it  is  the  bodily 
powers  that  have  lapsed  or  are  lapsing  and  not,  as  a  rule,  the  mental  fac- 
ulties. A  philosopher  once  said  that  a  woman  was  as  old  as  she  looked 
and  a  man  as  old  as  he  felt.  While  this  aphorism  is  true,  old  age  is  per- 
haps most  aptly  defined  by  the  statement  that  "a  person  is  as  old  as  his 
arteries."  This  would  seem  to  be  a  correct  explanation  of  the  term  old 
age,  for  when  the  arteries  have  hardened,  or  are  becoming  hardened,  the 
''decensus  Averni"  has  commenced.  As  Allbutt  states  in  his  work  on 
arteriosclerosis,  we  recognize  now,  all  of  us,  that  in  the  lapse  of  man's 
years,  one  long  reckoning  of  his  mortality  is,  and  from  all  known  ages 
has  been,  written  on  the  walls  of  his  vessels.  We  may  assume  that  in 
primitive  man,  by  external  conditions,  if  not  by  innate  capacity,  life  was 
of  comparatively  brief  duration.  Domestic  animals  seem,  as  a  role,  not 
to  live  long  enough  to  use  up  their  arteries — or  not  to  live  long  enough  to 
abuse  them — and  among  these  creatures  atheroma,  although  not  unknown, 
has  not  been  commonly  observed. 

Arteriosclerosis,  then,  may  be  taken  as  the  sign  manual  of  decaying 
physical  powers  (17),  that  is,  of  old  age,  and  the  person  who  has  hardened 
arteries  may  be  termed  old.  Premature  senility  is  far  more  frequent 
under  the  trying  conditions  of  civilized  life  than  when  life  is  passed  under 
natural  conditions.  The  artificial  life  of  cities,  sedentary  occupations, 
the  stress  and  strain  of  business,  and,  above  all,  unhygienic  habits  of  living, 
of  which  the  most  harmful  are  overeating,  errors  of  diet  and  too  great 
indulgence  in  spirituous  beverages,  combine  to  place  old  arteries  in  young 
bodies  and  to  shorten  greatly  the  normal  span  of  life.  One  cannot  "burn 
the  candle  at  both  ends"  with  impunity. 

First,  it  may  be  as  well  to  deal  with  the  means  for  preventing  old  age, 
and,  as  it  appears  to  have  been  decided  that  diet  is  the  prominent  factor  in 
its  production,  the  attempt  will  be  made  to  show  how  this  is  so.  According 
to  Allbutt,  one  form  of  arteriosclerosis  is  due  to  the  excessive  or  relatively 
excessive  consumption  of  meat  and  wine,  and  this  form  is  accompanied 
by  a  persistence  of  high  arterial  pressure.  Conheim  recognized  high  blood 
pressure  and  big  heart  in  gluttons.  Traube  was  one  of  the  first  in  recent 
times  to  marshal  clinical  evidence  on  "luxus  consumption"  and  to  argue 
the  question  on  scientific  lines.  Frantzel  followed  him,  with  the  theory 
that  with  gluttony  arose  an  overcharge  of  the  veins  and  a  fall  of  centrifu- 
gal velocity,  which  propagated  a  rise  of  pressure  backwards  to  the  capil- 


DIET    IN    OLD    AGE  435 

laries  and  arteries.  The  fact  must  not  be  forgotten  that  the  arteries  of  the 
alimentary  tract  are  among  tlie  most  muscular  in  the  body  and  have  a  very 
complex  nervous  endowment — a  mingled  vasoconstrictor,  vasodilator  and 
vagus  supply;  and  in  no  arteries  is  medical  hypertrophy  without  calcifi- 
cation so  well  marked  and  so  palpable.  This  change,  even  when  absent 
elsewhere  in  the  system,  may  be  found  here.  Stengel  emphasizes  as  causes 
overfeeding  and  hereditary  predisposition,  and  says  that  regulation  of  diet 
and  habits,  if  it  cannot  cure,  may  alleviate  the  malady  even  in  its  ad- 
vanced stages.  Sir  Lauder  Brunton,  Dr.  W.  Russell  and  many  others  are 
of  the  same  opinion.  Allbutt(18)  says  that  we,  as  other  engines,  differ 
widely  among  ourselves,  not  only  in  the  quantities  of  food  we  need  for 
given  work,  but  also  in  our  capacity  for  dealing  with  it  economically.  For 
example,  a  small  eater  may  be  a  bad  metabolizer.  He  would,  therefore, 
urge  that  while  one  man  can  be  gluttonous  with  impunity,  and  another 
on  a  moderate  diet  become  "plethoric,"  nevertheless,  the  average  man  who 
indulges  his  appetite  for  food  and  drink,  especially  if  his  habits  be  seden- 
tary, runs  no  little  risk  of  high  arterial  pressure  and  of  imperiling  the 
integrity  of  his  arteries.  Huchard  attributes  the  spread  of  arteriosclerosis 
to  the  increased  use  of  meat  during  the  nineteenth  century.  As  Fanny 
Burney  neatly  put  it,  "Tharle's  miscalculation  of  his  digestive  powers 
ended  in  apoplexy."  Another  witty  person  remarked  that  a  good  cook  is 
more  to  be  feared  when  one  is  in  perfect  health  than  a  bad  doctor  when 
one  is  ill.  However,  whether  mere  overfeeding  apart  from  a  toxemia  can 
raise  the  blood  pressure,  as  if  by  a  parenchymatous  surfeit,  is  a  question 
as  yet  unanswered.  But  we  do  know  that  overeating  and  overdrinking 
frequently  bring  about  chronic  constipation  and  intestinal  stasis,  which 
result,  more  often  than  not,  in  alimentary  toxemia.  The  blood  becomes 
surcharged  with  the  end  products  of  protein  digestion — toxic  materials — 
and  if  this  condition  be  allowed  to  persist,  blood  pressure  is  raised,  the 
arteries  begin  to  harden,  the  natural  powers  of  the  body  abate,  and,  in 
short,  the  individual  is  on  the  high  road  to  old  age. 

Wlien  discussing  overeating  and  injudicious  diet  as  factors  in  bringing 
about  untimely  senility,  it  should  be  well  understood  that  these  are  by  no 
means  the  only  causes.  There  are  persons  who,  no  matter  how  much  they 
may  abuse  their  bodies  in  this  direction,  still  live  to  be  old  in  years,  whose 
arteries  do  not  harden  prematurely,  and  who,  although  gross  eaters  and 
drinkers,  continue  to  enjoy  life.  On  the  other  hand,  there  are  spare  people 
who  do  not  eat  or  drink  to  excess,  yet  their  arteries  harden,  they  exhibit 
the  symptoms  of  senility  before  their  time,  and  become  old  prematurely. 
Their  metabolism  is  probably  defective.     In  spite  of  such  exceptional 


436  DIET    IN    PHYSIOLOGICAL    PERIODS 

cases,  there  is  little  doubt  that  errors  of  diet,  in  the  direction  chiefly  of 
self-indulgence,  are  largely  responsible  for  the  great  increase  of  chronic 
diseases — more  frequently  than  not  accompanied  by  arteriosclerosis — so 
melancholy  a  feature  of  modern  life,  and  that  diet  does  play  a  part,  the 
importance  of  which  can  scarcely  be  overestimated,  in  the  causation  of 
certain  conditions  distinguished  by  hardening  of  the  arteries.  Theognis, 
an  old  Greek  writer,  said:  "Surfeit  has  killed  more  men  than  famine," 
and  perhaps  this  saying  is  even  truer  to-day  than  when  it  was  penned. 
Surfeit  helps  to  bring  on  old  age,  and  to  prevent  this  occurrence,  food  and 
drink  should  be  taken  sparingly.  As  the  diet  calculated  to  prevent  old 
age  is  much  the  same  as  that  best  suited  to  those  who  have  become  prema- 
turely old  or  who  are  old,  that  question  will  be  dealt  with  when  diet  for 
the  aged  is  discussed. 

The  warding  oif  of  old  age  is  obviously  of  greater  concern  than  its 
treatment  when  it  has  come (19),  for  after  the  arteries  have  become  hard- 
ened there  is  no  means,  medicinal  or  dietetic,  which  will  bring  back  their 
pristine  softness  and  flexibility.  Remedial  treatment  by  diet  and  drugs, 
mainly  by  diet,  may  greatly  prolong  life,  but  will  not  cure  the  condition. 
For  these  very  substantial  reasons  those  who  are  young,  and  those  who 
lead  an  indoor  life,  in  particular,  should  see  to  it  that  they  exercise  a  wise 
moderation  as  regards  food  and  drink  and  a  due  discretion  as  to  the  kind 
of  food.  Observe  a  dictum  of  Hippocrates  that  "everything  in  excess  is 
unusual  to  nature." 

With  regard  to  diet  in  old  age,  the  consensus  of  opinion  of  those  who 
have  studied  the  subject  is  that  less  food  is  needed  than  at  other  periods 
of  life.  In  fact,  this  is  not  a  matter  of  opinion,  but  of  exact  knowledge. 
In  youth  we  are  going  uphill,  in  old  age  downhill.  In  childhood  and  in 
early  youth  the  physiological  powers  are  concerned  with  building  up  the 
organism  and  developing  its  various  functions,  and  an  ample  supply  of 
food  is  required  to  further  these  operations.  In  these  days  the  supply 
exceeds  the  losses  and  acts  in  developing  the  organism,  and  the  body 
increases  in  height  and  weight.  The  child  or  youth  can  eat,  and  indeed 
needs,  an  amount  of  food  which  the  ordinary  adult  would  find  beyond  his 
requirements.  Also  during  this  most  active  physiological  period  of  life 
the  impaired  cells  are  regenerated  rapidly  and  with  ease,  and  new  cells 
spring  i.p  like  flowers  in  the  spring  and  more  than  counterbalance  the 
decay  of  the  affected  ones,  I^everthpless,  the  time  comes  when  the  proc- 
esses of  decay  and  repair  are  exactly  balanced,  and  the  body  has  reached 
its  full  growth  or  maturity. 

On  reaching  manhood  the  individual  generally  acquires  the  prevailing 


DIET    IN    OLD    AGE  437 

dietetic  habits  of  his  associates,  with  little  disposition  to  question  their 
suitability  to  himself.  If  he  leads  an  active  life  and  has  plenty  of  exercise 
in  the  open  air,  he  may  largely  exceed,  both  in  quantity  and  variety  of 
food,  what  is  necessary  to  supply  the  demands  of  his  system  without  pay- 
ing a  very  exorbitant  price  for  the  indulgence.  A  "bilious  attack"  at  in- 
tervals affords  a  safety  valve  and  gets  rid  of  the  undesirable  balance  which 
remains  in  the  case  of  every  hearty  eater.  In  the  normal  condition  of 
things  this  state  of  affairs  is  maintained  for  many  years.  After  the  first 
half  or  so  of  life  has  passed  away,  however,  instead  of  producing  these 
periodical  attacks  of  sickness,  the  unemployed  material  may  be  relegated 
in  the  form  of  fat  to  be  stored  on  the  external  surface  of  the  body  or  to  be 
packed  among  the  internal  organs,  producing  obesity  to  a  greater  or  less 
extent.  There  are  some  individuals  who  do  not  seem  to  be  able  to  store 
fat,  however  rich  their  diet  may  be  or  however  inactive  their  habits.  In 
such  persons,  and  on  occasions  in  those  who  do  store  fat,  the  excess  of  food 
material  ingested  must  go  somewhere  to  produce  disease  in  some  other 
form,  probably  at  first  interfering  with  the  action  of  the  liver,  the  next 
appearing  as  gout  or  rheumatism,  or  as  the  cause  of  fluxes  and  obstruc- 
tions of  various  kinds.  Gout  is,  to  some  extent,  a  safety  valve  in  the  same 
way  as  bilious  attacks  in  youth,  except  that  it  is  really  damaging  to  the 
constitution  and  materially  injures  it.  Up  to  the  time  of  middle  age,  if  a 
person  be  robust  and  vigorous,  and  possesses  a  strong  digestion,  he  can  con- 
vert a  large  mass  of  food  into  fluid  aliment  suitable  for  absorption  into  the 
system.  Moreover,  his  eliminating  powers  are  active  and  can  pass  out  of 
the  body  superfluous  material  otherwise  destined  to  produce  mischief  in 
some  form.  As  he  advances  in  years,  however,  his  powers  of  elimination 
diminish  proportionately ;  less  niitriment  should  therefore  be  taken,  and 
the  kind  of  food  in  many  cases  should  be  difi^erent.  A  due  relation  should 
be  preserved  between  the  "income"  and  "output,"  and  if  this  be  neglected 
for  any  considerable  time,  injury  will  be  done  to  some  of  the  organs  or 
functions  of  the  body. 

It  must  be  remembered  that,  even  if  the  body  be  in  a  healthy  condition 
in  normal  old  age,  there  is  a  great  difference  between  the  health  of  youth 
and  that  of  age.  In  youth  vitality  is  strong  and  the  recuperative  powers 
are  great,  the  abundant  vital  forces  render  the  organism  elastic  so  that 
severe  illness  does  not  unduly  drain  the  system,  and  there  is  a  reserve  of 
energy  which  can  be  called  upon,  and  which  is  generally  equal  to  the 
demands.  In  old  age  there  is  not  this  reserve  force,  the  constitution  is  en- 
feebled and  has  lost  much  of  its  resiliency,  vitality  is  weak,  the  spring 
of  youth  is  lacking  and  no  longer  acts  with  a  force  equal  to  that  with  which 

128 


438  DIET    IJ^   PHYSIOLOGICAL   PERIODS 

it  is  expended — in  short,  the  body  cannot  respond  to  the  demands  made 
upon  it  as  of  yore.  As  Tibbies  points  out,  slight  deviations  from  the 
normal  performance  of  function  occur,  which  may,  however,  for  a  long 
time  be  imperceptible.  These  gradually  increase  in  extent  until  they 
become  manifest  indications  of  a  failure  of  the  bodily  powers  or  of  dis- 
ordered health.  Exertion  produces  results  which  formerly  would  not  have 
been  noticeable  and  exhaustion  is  out  of  all  proportion  to  the  work  per- 
formed. Among  the  most  marked  indications  of  failing  metabolism  and 
consequent  disturbance  of  the  functions  are  symptoms  of  disorder  of  the 
alimentary  system.  With  old  age  and  approaching  old  age  the  muscular 
power  of  the  whole  system  wanes.  The  muscular  fibers  of  the  stomach  and 
bowels  participate  in  this  decline.  But,  although  the  digestive  powers  and 
those  of  assimilation  diminish,  the  appetite  often  remains  good,  or  in  some 
persons  the  custom  of  eating  and  drinking  freely  is  so  ingrained  that  it 
has  become  a  habit.  More  food  is  therefore  consumed  than  can  be  digested 
or  absorbed,  i'nd,  as  mentioned  previously,  the  unabsorbed  portion  prob- 
ably undergoes  putrefaction,  and  in  the  end  produces  that  condition  known 
as  alimentary  toxemia ;  high  blood  pressure  ensues,  and  arteriosclerosis  is 
aggravated. 

The  pathological  changes  incident  to  age  have  been  summed  up  by 
Metchnikoff  as  a  sclerosis  which  may  affect  the  brain,  liver,  kidneys  and 
other  organs,  but  is  mostly  seen  in  the  blood  vessels.  There  are  many 
other  degenerative  changes,'  but  to  mention  all  of  these  would  be  superflu- 
ous.   Arteriosclerosis  is  the  most  important. 

Perhaps  too  great  emphasis  has  been  laid  on,  the  point  that  arterio- 
sclerosis is  synonjTnous  with  old  age.  We  intend  to  convey  by  this  state- 
ment that  thickening  of  the  arteries  may  be  considered  asi  physiological 
old  age.  It  may  occur  prematurely,  when  it  is  termed  premature 
senility,  and  to  a  greater  or  less  extent  it  is  generally  an  accompaniment 
of  advanced  years,  though  by  no  means  always.  However,  whether  the 
condition  be  that  of  physiological  old  age  or  of  old  age  without  obvious 
injury  of  the  arteries,  the  question  of  diet  is  all  important  In  healthy 
old  age,  where  the  organs  and  functions  show  only  the  normal  and  some- 
times but  comparatively  few  degenerative  changes,  there  is,  nevertheless, 
always  a  certain  failing  of  the  bodily  powers.  There  are  variations  and 
changes  accompanying  the  progressive  deterioration  of  the  organism  in 
which  all  the  organs  and  functions  participate  more  or  less,  although  it  is 
doubtful,  except  in  the  case  of  definite  disease  of  the  excretory  organs, 
whether  the  aged  suffer  in  any  marked  degree  from  their  inefiiciency. 
Constipation  is  usually  the  most  troublesome  affliction  of  senility  and  the 


DIET    11^    OLD    AGE  439 

phagocytes  are  particularly  active.  The  object,  then,  should  be  to  discover 
a  means  to  strengthen  the  most  valuable  cellular  elements  on  the  one  hand, 
and  weaken  the  phagocytosis  on  the  other.  The  elixir  of  life  is  yet  to  be 
found  and,  therefore,  other  and  more  prosaic  methods  must  be  sought  to 
achieve  this  end.  While  the  problem  of  how  to  effect  this  is  still  far  from 
solution,  the  consensus  of  opinion  is  that  judicious  eating,  combined  with 
hygienic  modes  of  life  in  other  respects,  will  do  most  in  this  direction,  and 
that  diet  is  the  main  staff  upon  which  to  lean. 

All  are  agreed  that  in  old  age  the  diet  should  be  lighter  than  in  younger 
years,  and  that  the  amount  of  food  eaten  should  vary  with  the  needs  of  the 
individual.  The  food  should  be  of  an  easily  digestible  kind,  and,  accord- 
ing to  Friedenwald  and  Ruhrtih,  it  should  be  given  in  smaller  quantities 
at  a  time,  and  the  intervals  between  meals  should  be  shortened. 
!Nascher(19),  on  the  other  hand,  says  that  the  oft-repeated  advice  that  the 
aged  should  eat  little  and  often  is  irrational,  for  digestion  is  naturally 
slower  in  old  age  and  frequent  feedings  keep  the  stomach  constantly  at 
work,  there  being  always  a  mass  of  food  in  the  stomach  in  different  stages 
of  digestion.  This,  he  thinks,  is  the  most  common  cause  of  flatulence, 
heartburn  and  senile  gastric  catarrh,  with  its  attendant  pyrosis  and  gas- 
trodynia.  In  old  age,  according  to  this  writer,  food  should  not  be  taken 
oftener  than  once  in  live-  or  six-hour  intervals,  at  fixed  houi-s  each  day. 
The  number  of  meals,  like  the  time  of  day  at  which  the  principal  meal  is 
taken,  is  a  matter  of  habit,  often  of  nationality,  and  does  not  affect  the 
rule. 

As  at  all  adult  periods  of  life,  if  there  be  a  tendency  to  obesity,  food 
that  is  apt  to  be  converted  into  fat  should  be  given  in  diminished  amounts. 
The  proteins  should  be  somewhat  lessened  from  time  to  time.  Some 
authorities,  including  Sir  Henry  Thompson,  advocate  a  vegetarian  diet 
for  the  old,  believing  in  the  proverb,  "Much  meat,  many  maladies,"  but 
others  see  no  valid  reason  why  animal  proteins  should  not  be  given  in 
moderation,  especially  if  the  subject  has  been  a  consistent  meat  eater. 
There  are  those  who  regard  heavy  suppers  as  an  abomination.  Possibly 
such  meals  are  blazing  indiscretions  at  any  period  of  life,  and  certainly 
in  old  age  they  should  be  most  severely  condemned.  Likewise  eating  be- 
tween meals  is  a  habit  that  is  discountenanced,  although  it  is  probably  less 
harmful  than  is  supposed.  The  personal  equation  with  regard  to  diet  and 
particular  kinds  of  food  holds  good  just  as  much  with  the  aged  as  with  the 
person  in  the  prime  of  life.  TVhen  an  individual  has  reached  the  age  of 
60  years  he  ought  to  have  learned  which  articles  of  food  disagree  with  him, 
and  should  refrain  from  these.    A  diet  laid  dowTi  on  strictlv  scientific  lines 


440  DIET    IN    PHYSIOLOGICAL   PERIODS 

will  not  suit  all  old  people,  and  a  fairly  wide  latitude  should  be  allowed  for 
personal  likes  and  dislikes  and  for  individual  idiosyncrasies.  Especially 
should  monotony  in  diet  be  avoided,  no  matter  how  perfectly  adapted  it 
may  seem  to  be  from  the  laboratory  standpoint.  Cowper's  saying,  that 
'Variety  is  the  spice  of  life  and  gives  it  all  its  flavor,"  applies  with  as 
much  truth  to  food  as  to  other  things. 

Now  it  is  allowed  that  food  is  perhaps  the  most  essential  factor  in 
warding  oif  old  age,  or  rather  in  avoiding  many  of  the  disagreeable  accom- 
paniments of  old  age  which  are  certain  to  occur  if  the  habit  of  indulging  in 
food  to  excess  or  of  eating  unsuitable  viands  is  persisted  in.  Dr.  Harry 
Campbell  (20)  states  that  in  his  opinion  the  most  suitable  dietary  for  the 
aged  is  that  which  constitutes  the  ideal  diet  for  many  in  general.  Such 
a  dietary  demands  (a)  moderation  in  quantity,  (&)  simplicity  in  quality, 
and  (c)  the  avoidance  of  those  starchy  foods  which  are  apt  to  slip  into 
the  stomach  without  having  first  been  adequately  insalivated.  A  moderate 
diet  is  one  just  sufficient — supposing  the  various  foodstuffs,  fats,  proteins, 
etc.,  to  be  properly  balanced — to  maintain  a  person  at  the  slightest  weight 
consistent  with  the  most  perfect  health  of  which  he  is  capable.  Simplicity 
is  constituted  by  such  items  as  bread,  plain  biscuits,  plain  puddings, 
plainly  cooked  vegetables,  fruit,  meat,  fowl,  fish,  milk,  Cheddar  cheese, 
tea,  coffee,  cocoa,  salt.  Dishes  calculated  to  tickle  the  palate  are  not  in- 
cluded in  the  simple  diet ;  neither  are  alcohol  nor  condiments  other  than 
salt  and,  occasionally,  pepper  and  mustard.  Avoidance  of  soft  starchy 
foods  is  essential.  All  through  life,  starch  should,  as  far  as  possible,  be 
taken  in  a  form  compelling  mastication.  Soft  starchy  foods  such  as  pud- 
dings are  only  admissible  on  condition  that  they  be  thoroughly  masti- 
cated. 

The  diet  of  early  man  conformed  to  these  three  requirements.  It  was 
simple,  consisting  as  it  did  of  unprepared  animal  and  vegetable  substances. 
The  quantity  was  not,  on  the  whole,  in  excess  of  physiological  needs ;  and 
all  the  starchy  food,  being  raw,  had  to  be  abundantly  masticated  in  order 
to  break  up  the  non-digestible  cellulose  framework  and  thus  liberate  the 
contained  foodstuffs.  When  we  come  to  compare  the  ideal  with  the  actual 
in  the  present  day,  the  contrast  is  discouraging.  Too  often  the  stomach 
and  bowels  are  burdened  with  an  excess  of  food  and  harassed  by  a  too 
great  variety.  Efficient  digestion  is  rarely  possible  under  these  circum- 
stances, and  the  blood  is  surcharged  with  nutrient  matter,  much  of  which 
is  in  an  imperfectly  digested  form.  The  tissues  being  thus  bathed  in  nn 
overrich  and  perverted  plasma,  metabolism  fails  to  proceed  normally  and 
health  suffers. 


DIET    m    OLD    AGE  441 

Inasmuch  as  after  early  adult  life  there  is  a  steady  waning  in  the 
ability  of  the  organism  to  digest  and  metabolize  the  food  taken,  it  follows 
that  the  need  to  conform  to  the  requirements  of  the  ideal  dietary  becomes 
increasingly  pressing  with  advancing  years. 

Campbell  elaborates  the  points  which  we  have  touched  upon,  with  re- 
gard to  the  capacity  of  the  organism  to  cope  with  different  kinds  of  food, 
the  influence  of  custom  and  idiosyncrasy,  as  well  as  of  age,  and  his  remarks 
are  so  instructive  that  it  will  be  fitting  to  refer  to  them  at  length.  As  to 
the  flrst  of  these  influences,  while  one  should  be  cautious  in  recommending 
to  an  aged  person  a  diet  very  different  from  that  to  which  he  has  for  years 
been  accustomed,  the  experience  derived  from  prisons,  workhouses  and 
similar  institutions  shows  that  the  ability  of  the  aged  to  adapt  themselves 
to  novel  kinds  of  diet  is  by  no  means  small.  It  is  indeed  astonishing  what 
can  be  achieved  in  this  direction  if  the  necessary  pressure  be  brought  to 
bear. 

The  factor  of  idiosyncrasy  is  important.  Individuals  differ  greatly, 
quite  irrespective  of  age,  in  their  digestive  and  metabolic  capacities.  We 
meet  with  children  who  are  unable  to  tolerate  foods  which  old  people  can 
digest  quite  easily,  and  with  others  who  are  made  ill  by  even  a  slight  ex- 
cess, while  their  grandfathers  can,  perhaps,  consume  large  quantities  with 
comparative  impunity.  Some  old  people  have,  in  fact,  prodigious  powers 
of  digestion  and  metabolism,  and  we  may  look  upon  them  as  corresponding 
in  the  physiological  sphere  to  the  Shakespeares  and  Newtons  in  the  realm 
of  mind.  They  are  physiological  geniuses.  Most  of  these  old  people 
would,  however,  doubtless  enjoy  better  health,  be  more  amiable  and  have 
•greater  consideration  for  others,  on  a  more  abstemious  diet ;  nevertheless, 
in  regulating  their  food,  we  must  make  due  allowance  for  their  prodigious 
powers,  though  not  infrequently,  by  the  gratification  of  their  inordinate 
appetites  they  are  paving  the  way  for  many  and  diverse  complications. 
If  they  have  high  blood  pressure  and  exhibit  any  of  the  symptoms  of  apo- 
plexy, the  amount  of  the  food  they  take  should  be  limited. 

According  to  Friedenwald  and  Iluhrah(21),  milk  may  be  taken  in  all 
forms  when  easily  digested,  and  when  it  is  not  well  borne  the  addition  of 
warm  vichy  or  warm  water  will  often  prove  helpful,  or  the  milk  may  be 
diluted  with  cereal  gruels,  or  have  sodium  citrate,  one  grain  to  the  ounce, 
added  to  it.  Beef  tea  is  often  useful,  and  beef  juices  may  be  used  if  de- 
sired. Eggs,  lightly  cooked  or  beaten  up  with  milk  are  very  good,  as  are 
nutritious  soups,  such  as  chicken  or  fish  purees,  mutton,  beef  or  chicken 
broth.  Young  and  tender  chicken,  game  and  other  tender  meats  and  good 
quality  potted  chicken  or  other  potted  meats  may  be  taken.    Sweetbreads 


442  DIET    IN    PHYSIOLOGICAL   PERIODS 

are  easily  digested  if  fresh  and  properly  prepared,  but  may  be  contra- 
indicated  on  account  of  the  purin  nitrogen  contained.  White  fish,  such  as 
sole,  whiting,  smelts  and  the  like,  are  all  suitable,  and  are  best  when 
boiled.     Crisp  grilled  bacon  is  relished  by  many. 

The  following  foods  are  also  suitable :  bread  and  milk  made  with  the 
crumbs  of  stale  bread  and  without  lumps ;  porridge  and  oatmeal  gruel ; 
puddings  of  ground  rice,  tapioca,  arrowroot,  sago  or  macaroni,  with  milk 
or  eggs,  and  flavored  with  spices  or  served  with  fruit  jelly ;  bread  and  but- 
ter, the  latter  at  least  a  day  old ;  rusk,  to  be  soaked  in  tea  or  milk  and 
water;  prepared  foods,  consisting  of  predigest^d  starches.  At  this  age 
digestive  ferments  are  scantily  provided  by  the  digestive  organs,  and 
soluble  carbohydrates  are  valuable  for  maintaining  the  body  heat.  All 
farinaceous  foods  should  be  subjected  to  a  high  temperature  for  some  time 
during  the  cooking  process,  so  as  to  render  the  starch  granules  more  di- 
gestible. Vegetable  purees  of  all  kinds  may  be  taken  in  moderation,  e.g., 
potatoes,  carrots,  spinach  and  other  succulent  vegetables.  Potatoes  and 
fresh  vegetables  are  a  necessity ;  if  omitted,  a  scorbutic  state  may  be  en- 
gendered. Stewed  celery  and  stewed  Spanish  or  Portugal  onions  lend 
variety  to  the  diet,  and  stewed  or  baked  fruits,  fruit  jellies,  and  the  pulp 
of  perfectly  ripe  raw  fruits  may  be  taken  in  small  quantity. 

With  respect  to  a  diet  for  old  age  based  on  scientific  investigations, 
Voit(22),  who  founded  his  conclusions  on  researches  made  by  Forster, 
considered  that  the  conditions  of  old  age  indicate  a  ration  of  0.8  the  value 
of  that  for  men  and  women  of  mature  age,  in  good  health  and  doing  mod- 
erate work,  as  follows : 

VOIT'S  DIETARY  STANDARD  FOR  AGED  PERSONS 


Protein 


Energy 


Old  man,  no  work 

"      light  work .  .  . 

Old  woman,  no  work. . . 

light  work. 


90  grams 

2,116  calories 

100      « 

2,689 

80      « 

1,831        « 

85      « 

2,096 

In  this  standard,  as  Tibbies  points  out,  no  age  is  stated,  and  the  amount 
of  protein  is  considered  by  some  authorities  to  be  too  great. 

]VIaurel(28)  points  out  that,  as  age  increases,  the  amount  of  external 
muscular  work  becomes  smaller,  internal  muscular  work  becomes  less, 
and  therefore  the  nutritive  requirements  of  the  body  are  correspondingly 
decreased. 


DIET    IN    OLD    AGE  443 

MAUREL'S  MAINTENANCE  RATIONS  FOR  OLD  PEOPLE 


Age 

Adult 

Fifty  to  seventy  years — 
Seventy  years  and  over .  . 
Extreme  old  age 


Energy  per  Kilo 


35  to  38  calories 
30  «  35       « 
25  «  30 
20  «  25 


Langworthj(24),  by  using  Maurel's  maximum  factors  and  taking  the 
average  weight  of  old  men  and  women  to  be  the  same  as  found  by 
Quatelet(25),  has  framed  the  following  table  to  show  the  estimated  re- 
quirements of  aged  people : 

LANGWORTHY'S  DIETARY  STANDARD  FOR  THE  AGED  AND  INFIRM 


Subjects 

Age 

Average 

Weight 

Protein 
required 

Energy 
required 

Men 

Years 
60 
70 
80 
90 
60 
70 
80 
90 

Kilos 
65.50 
63.03 
61.22 
57.83 
56.73 
53.72 
51.51 
49.34 

Pounds 
144.1 
138.7 
134.7 
117.2 
124.8 
118.2 
113.3 
108.5 

Grams 
81.9 
78.8 
45.9 
43.4 
70.9 
67.2 
38.6 
37.0 

Grams 
1,965 
1,891 

« 

u 

1,531 

a 

1,446 

Women 

1,702 

« 

1,612 

a 

1,288 

u 

1,234 

Kosevi(2G)  found  that  the  food  consumed  by  women  aged,  seventy- 
six  and  seventy-eight  years  was  as  follows : 

KOSEVI'S  MAINTENANCE  RATION  FOR  THE  AGED 


Protein 


Calories 


Woman,  seventy-six  years,  45  kilos,  first  diet 

"         «       «      45     «      second  diet .  . 

"      45     «      third  diet. . . . 

Woman,  seventy-eight  years,  61  kilos,  first  diet. . . 

"         "      61     "      second  diet 

«      61     "      third  diet.. 


77  grams 

1,361 

66      " 

1,361 

66      « 

1,165 

41      « 

1,275 

41       " 

1,575 

67      « 

1,207 

Guriev  of  Petrograd  undertook  some  experiments  to  ascertain  the 
amount  of  protein  required  by  old  people,  and  to  study  the  metabolism  of 
nitrogen.  Five  men  were  selected  from  sixty-eight  to  eighty-eight  years 
The  three  younger  were  hale  and  hearty,  the  two  elder  somewhat 


of  age. 


444 


DIET    IX    PHYSIOLOGICAL   PERIODS 


decrepit.  The  dietaries  were  given  in  each  case,  the  first  including  meat 
and  milk,  the  second  beef  tea,  but  no  meat  or  milk.  The  dietaries  and 
nitrogen  balance  are  given  below : 

NITROGEN  METABOLISM  IN  OLD  AGE 


First  diet      (a).  ... 
Second  diet  (b) . .  . . 


Protein 
90  grams 
55      « 


Fat 
42  grams 

87      « 


Carbohydrate 
372  grams 
385      « 


Calories 
2,296 
2,615 


Age 


Man, 
68  years 


Man, 
74  years 


Man, 
75  years 


Man, 
88  years 


Man, 

88  years 


Dietary 


a)  Meat  100,  milk  250,  bread  600, 

butter  20,  sugar  60  grams; 
tea  1,800  c.c 

b)  Beef  tea  500,  tea  1,800  CO.;  po- 

tatoes 600,  bread  400,  butter 
70,  sugar  60  grams 

a)  Meat  142,  milk  500,  bread  600, 

butter  22,  sugar  60  grams; 
tea  1,200  c.c 

b)  Beef  tea  500  c.c;  potatoes  300, 

bread  500,  butter  90,  sugar  60 
grams;  tea  1,200  c.c 

a)  Meat  100,  milk  250,  bread  55, 

butter  20,  sugar  60  grams; 
tea  2,100  c.c 

b)  Beef  tea  500  c.c;  potatoes  600, 
bread  400,  butter  90,  sugar  60 
grams;  tea  2,160  c.c 

a)  Meat  100,  milk  500,  bread  600, 
butter  30,  sugar  60  grams; 
tea  1,530  c.c 

b)  Bread  340,  butter  120,  sugar  60, 

potatoes  400  grams;  tea  1,530 
c.c 

a)  Meat  100,  milk  250,  bread  600, 
butter  20,  sugar  60  grams; 
tea  2,200  c.c 

6)  Beef  tea  500  c.c;  potatoes  600, 
bread  400,  butter  90,  sugar  60 
grams;  tea  2,200  c.c 


Days 


5 

10 
8 
5 
7 
5 
5 
5 


Nitrogen 


Grams 

in 
Food 


12.7 


8.9 


17.4 


10.9 


13.0 


8.9 


15.1 


6.7 


13.7 


8.9 


Grams 

in 
Urine 


8.4 


6.5 


14.6 


7.7 


9.0 


6.7 


10.7 


4.3 


10.9 


Grams 

in 
Feces 


1.0 


.9 


1.2 


1.2 


1.2 


1.1 


1.8 


.14 


Gain 

or 

Loss 


+4.3 


+2.5 


+1.6 


+2.4 


+2.8 


+  .4 


+3.2 


+1.3 


+1.0 


+  .6 


The  conclusions  drawn  from  the  observations  were:  (a)  The  amount  of 
protein  ordinarily  consumed  by  old  men  may  be  diminished  if  an  abun- 
dance of  fat  and  carbohydrate  is  taken  to  replace  it.  (&)  The  assimilation 
of  nitrogen  by  old  men  is  somewhat  less  than  normal.     During  the  first 


DIET    IN    OLD    AGE  445 

dietary  the  assimilation  of  nitrogen  averaged  91.15  per  cent;  in  the  sec- 
ond diet  period,  86.17  per  cent.  The  assimilation  of  nitrogen  by  young 
men  on  a  similar  diet  was  found  to  be  94  per  cent.  In  the  first,  or  meat 
period,  the  ratio  of  incompletely  oxidized  products  to  urea  in  the  urine 
was  greater  than  normal ;  therefore,  the  metabolism  was  inferior  to  •  that 
of  young  men  on  a  similar  diet.  In  the  second,  or  non-meat  period,  this 
ratio  decreased  somewhat.  When  the  diet  contained  less  protein,  but  an 
abundance  of  fat,  the  subjects  maintained  their  usual  weight  and  health. 

The  recent  researches  of  Schlesinger  and  Neuman  upon  the  digestive 
functions  of  thirty  healthy  individuals  over  sixty  years  of  age  have  demon- 
strated that  while  starch  and  fat  are  thoroughly  digested,  the  digestion  of 
meat  is,  as  a  rule,  imperfect. 

According  to  Munk  and  Ewald(27),  a  man  doing  no  work  requires 
the  following  amount  of  food : 

Protein      Fat      Carbohydrates 

Man 90  grams    40  grams     350  grams 

Woman 80      «        35      «         300      « 

If  this  be  translated  into  ordinary  articles  of  diet,  it  would  mean: 
Meat,  80.3  grams;  milk,  |  pint;  bread,  10  oz. ;  biscuit,  2  oz. ;  butter,  1 
oz. ;  potatoes,  ^  lb. ;  sugar,  f  oz. ;  wine,  6|  oz. ;  coffee,  14  oz. 

Von  Xoorden(28)  has  suggested  the  following  scale  for  the  reduction 
of  the  fuel  value  of  the  dietary  of  the  aged : 

Age  in  Years  Percentage  of  Reduction 

60-70 10 

70-80 20 

SO 30 

Saundby,  in  his  book  on  "Old  Age,  Its  Care  and  Treatment,"  says  that 
the  diet  of  the  aged  should  be  reduced  in  amount  in  proportion  to  their  in- 
activity. So  long  as  they  can  work,  or  take  active  exercise,  they  may  enjoy 
the  diet  of  adult  life,  35  calories  per  kilogram  of  body  weight,  but  they 
should  be  careful  to  avoid  large  meals  and  indigestible  food.  On  account 
of  their  defective  teeth  all  food  should  be  easily  masticated,  as,  for  ex- 
ample, minced  or  pounded  meat  and  vegetables  in  puree.  The  diet  should 
contain  few  toxins,  especially  purins;  a  little  meat  once  a  day  may  be 
allowed,  preferably  at  the  midday  meal,  while  eggs  may  replace  meat  at 
the  evening  meal.  But  little  alcohol  is  required,  but  plenty  of  water 
should  be  taken.  Little  salted  food  should  be  given,  as  we  are  ignorant 
of  the  conditions  in  which  chlorids  are  elimiuatcrl. 


446 


DIET    IN   PHYSIOLOGICAL    PERIODS 


Old  persons  leading  more  or  less  vegetative  lives  require  a  smaller 
amount  of  food  than  active  adults.  We  may  take  it  that  30  calories  per 
kilo  is  a  sufficient  basis  for  their  dietaries,  and  if  they  are  obese  they 
should  do  with  less,  as  fat  ought  not  to  be  reckoned  in  estimating  the  fuel 
requirements.  Saundby  thinks  these  30  calories  might  be  made  up  by 
1  gram  per  kilo  of  protein,  1  gram  per  kilo  of  fat,  4  grams  per  kilo  of 
carbohydrates,  so  that  an  old  person  weighing  70  kilos  or  140  pounds 
might  be  allowed  70  grams  cf  protein,  70  grams  of  fat  and  280  grams  of 
carbohydrates,  which  would  give  a  little  over  2,000  calories  as  against 
2,450  calories  for  an  adult  of  the  same  weight  leading  a  moderately  active 
life.    Thus  the  daily  dietary  might  be  composed  of  the  following  articles : 

SAUNDBY'S  DAILY  DIETARY  FOR  THE  AGED 


Amount  of  Food 

Protein 

Fat 

Carbohydrate 

Calories 

Bread.  250  grams  (8  oz.) 

22.08 
17.9 
0.3 
0.0 
1.8 
27.0 
2.6 
0.21 

3.12 

19.6 

0.0 

0.0 

0.12 

7.0 

20.75 

24.3 

127.4 

26.88 

36.0 

29.2 

24.0 

0.0 

0.0 

0.15 

640 

Milk,  568  grams  (1  pt.) 

375 

Tapioca,  45  grams  (1  oz.) 

150 

Sugar,  30  grams  (1  oz.) 

120 

Potatoes,  120  grams  (4  oz.) 

Lean  meat,  100  grams  (3J^  oz.) .... 

Fat  bacon,  30  grams  (1  oz.) 

Butter,  30  grams  (1  oz.) 

105 
185 
187.5 
270 

Total 

71.89 

74.89 

243.63 

2032.5 

Tea  and  coffee,  beef  tea  and  bouillon,  green  vegetables  and  fruit 
in  moderation  contain  so  little  heat-forming  substances  that  they  may  be 
left  out  of  account,  but  may  be  added  to  the  diet. 

It  will  be  pertinent  to  the  subject  in  hand  to  interpolate  some  rules 
as  to  the  feeding  of  the  aged,  and  a  diet  table  compiled  by  Dr.  Reynold 
Webb  Wilcox  (29).  1.  Never  less  than  five  hours  between  meals.  2.  No 
solid  food  between  meals.  3.  Principal  meal  near  midday.  4.  All  meals 
to  be  as  dry  as  possible.  5.  Avoid  food  likely  to  cause  flatulence.  6.  Not 
more  than  5  oz.  of  fluid  with  each  meal.  Alcohol  only  for  those  who  are 
accustomed  to  its  use — J  oz.  of  brandy  or  whiskey  in  three  or  four  ounces 
of  water,  a  single  glass  of  port  or  sherry. 

Breakfast,  8  a.m.: 

Small  slice  of  toast,  IH  oz.,  with  butter;  one  soft-boiled  or  poached  egg,  or 
half  a  small  haddock  or  other  white  fish;  3  to  5  ounces  of  tea  or  coffee  with 
cream  and  sugar;  tea  may  be  replaced  by  cocoa  or  milk  wnth  hot  water;  well- 
boiled  oatmeal,  3  to  4  ounces  with  4  to  5  ounces  of  milk  may  be  substituted 
for  tea. 


DIET    m   OLD   AGE 


447 


Dinner,  1  p.m.: 

Two  courses  fish  or  meat;  pudding  or  fruit;  white  fish,  short  fiber,  boiled,  steamed 
or  broiled  half;  small  chicken,  white  meat  or  sweetbreads;  game,  lamb,  small 
potato  boiled  or  baked  or  a  small  portion  of  spinach;  pudding,  a  simple  milk 
pudding,  or  rice,  sago,  tapioca  or  suet;  fruit,  as  ripe  pears,  apples,  grapes, 
4  to  6  ounces;  hot  water  to  be  taken  if  desired. 

Tea,  5  p.m.: 

Tea  with  cream  and  sugar  but  no  food;  in  place  of  tea,  a  teaspoonful  of  solid 
beef  extract  in  hot  water  may  be  taken. 
Supper,  7  p.m.: 

White  fish  and  one  potato  or  toast  with  butter.  Milk  pudding  or  bread  and 
milk. 

10  p.m.: 

Five  ounces  of  hot  water  to  be  sipped.  For  the  relief  of  thirst,  beef  tea  or  hot 
water,  to  be  sipped  four  hours  after  each  or  the  principal  meal. 

Saundbj,  in  order  to  illustrate  the  distribution  of  the  amount  of  food 
in  his  table  still  further,  suggests  the  following  arrangement  of  meals : 

SAUNDBY'S  DAILY  DIETARY  FOR  THE  AGED  SHOWING  DISTRIBU- 
TION OF  MEALS 


NO.  I 


Breakfast 
^2  pint  of  tea 
3  oz.  milk 
}4:  OZ.  sugar 
3  oz.  bread 
}/2  oz.  butter 
1  oz.  bacon 


Dinner 
3M  oz.  meat 
4  oz.  potato 
1  oz.  tapioca 
4  oz.  milk 
}4  oz.  sugar 
1  oz.  bread 


Tea 

}4  pint  oi  tea 
3  oz.  milk 
}4  oz.  sugar 
3  oz.  bread 
}/2  oz.  butter 


Supper 
10  oz.  milk 
1  oz.  bread 


NO.  II 


3^  pint  coffee 
1  oz.  oatmeal 
6  oz.  milk 
}4:  oz.  sugar 
}/2  oz.  butter 
3  oz.  bread 


6  oz.  fish 
4  oz.  potato 
1  oz.  milk 
1  oz.  butter 
Stewed  fruit 
K  oz.  sugar 
1  oz.  bread 


J^  pint  tea 
3  oz.  milk 
3^  oz.  sugar 
3  oz.  bread 
}4  oz.  butter 


10  oz.  milk 
1  oz.  bread 


Another  dietary  for  an  old  person  of  seventy,  weighing  from  120  to  140 
pounds,  affording  1,950  calories,  would  contain: 

47  grams  albumin 
314      "      carbohydrates 
54      «      fat 
20      «      alcohol 


448  DIET    IK    PHYSIOLOGICAL    PERIODS 

Such  a  diet  may  be  thus  distributed : 

Morning  meal: 

Milk 8  oz. 

Sugar M  oz. 

Bread 2  oz. 

Butter J^  oz. 

Midday  meal: 

Bread 3  oz. 

Meat  or  fish 2  oz. 

Vegetables  or  fruit 2  oz. 

Beer K  pint 

Evening  meal: 

Bread 3  oz. 

Eggs 2  oz. 

Light  pudding 4  oz. 

Whiskey M  oz. 

The  caloric  value  of  a  diet  may  be  raised  easily  by  adding  to  the  fat 
in  the  form  of  butter,  cream,  fat  bacon,  suet  pudding  or  cheese.  With  re- 
gard to  cheese,  it  may  be  said  that  a  plain,  good,  wholesome  cheese  is 
peculiarly  well  adapted  as  a  food  for  the  aged.  It  is  palatable  and  nutri- 
tious and,  while  it  requires  sufficient  mastication  to  produce  insalivation, 
it  can  be  readily  masticated  by  the  toothless  or  by  those  who  lack  their 
full  quota  of  teeth.  Cod-liver  oil,  when  it  can  be  taken,  is  useful,  £fs  half 
an  ounce  of  oil  daily  will  afford  approximately  150  calories.  After  fat 
come  the  starches  and  sugars.  Cane  sugar,  as  almost  pure  carbohydrate, 
can  be  tolerated  in  only  small  quantities.  Old  men  who  have  been  meat 
eaters,  drinkers  and  smokers,  have  lost  their  taste  for  sweet  things,  and, 
in  fact,  often  have  a  distaste  for  them,  but  this  aversion  can  be  overcome. 
Cane  sugar  is  nourishing  and  by  some  British  authorities  is  highly  lauded 
in  the  treatment  of  arteriosclerosis.  It  is  better  assimilated  if  cooked,  as 
in  milk  puddings  or  added  to  fruit  well  stewed.  Raw  sugar  should  be 
viewed  somewhat  askance,  as  it  is  likely  to  upset  the  digestion,  but  small 
quantities  will  do  no  harm.  Perhaps  as  much  milk  as  can  be  digested 
without  discomfort  may  be  taken,  but  a  pint  daily  is  sufficient.  Sour 
milk  of  late  has  been  given  great  prominence  by  Metchnikoff,  and  is 
undoubtedly  useful  in  old  age.  If  too  sour  for.  the  palate,  it  may  be 
sweetened  with  sugar,  honey,  jam  or  treacle,  and  may  be  added  to  por- 
ridge, hominy,  boiled  rice,  or  to  any  breakfast  food.  It  is  especially  val- 
uable, being  slightly  laxative,  in  cases  of  chronic  constipation,  the  greatest 
bane  of  old  age.  Metehnikoff  recommended  its  use  on  account  of  its 
power  of  diminishing  the  toxicity  of  the  bowel  contents,  and  thereby  pre- 


DIET    IN    OLD    AGE 


449 


venting  those  senile  degenerative  changes  which  he  deems  largely  the  result 
of  intestinal  intoxication.  Buttermilk  is  also  valuable  when  whole  milk 
cannot  be  properly  digested.  The  casein  it  contains  furnishes  its  nutritive 
value,  but  its  caloric  value  is  on  the  average  only  about  half  of  that  of 
milk.  Kumiss  or  kefir  when  fresh  acts  as  a  laxative.  It  is  easily  digested 
and  highly  nutritious  in  large  quantities  from  a  pint  and  a  half  to  three 
pints  daily. 

Campbell  (30),  who  is  the  chief  prophet  of  thorough  mastication  and 
spare  living,  points  out  that  the  appetite  for  plain  food  may  continue  to 
extreme  old  age.  At  one  of  the  large  London  workhouses  the  daily  diet 
for  men  over  GO  years  of  age  is  as  follows :  Bread,  20  oz. ;  margarin,  1  oz. ; 
sugar,  1  oz. ;  meat,  4  oz. ;  potatoes,  8  oz. ;  greens,  4  oz. ;  pudding,  once 
weekly;  stewed  fruit,  once  weekly;  tea,  2  pints;  salt  and  pepper  daily; 
mustard  once  a  week;  no  alcohol.  Campbell  says  that  the  inmates  con- 
sume it  all  and  enjoy  it  thoroughly,  complain  very  little  of  indigestion, 
and,  what  is  more  surprising,  suffer  little  fr^m  constipation. 

The  alimentary  pastes  have  high  food  value  and  are  easily  digested 
if  cooked  simply.  Thus  they  are  eminently  suitable  as  a  diet  or  part  of  the 
diet  of  old  people.  According  to  Combe,  they  are  composed  of  the  gluten 
of  wheat  with  a  considerable  proportion  of  starch,  and  are  of  especial  value 
in  the  dietetics  of  intestinal  diseases.  Not  only  is  the  nutritive  value 
of  these  foods  high,  but  they  are  cheap.  They  cost  but  little  more  than 
rice,  sago  and  tapioca,  and  have  at  least  double  the  nutritive  value. 

ALIMENTARY  PASTES:  FOOD  VALUE 


Protein 

Carbo- 
hydrate 

Fat 

Calories  per 
300  Grams 

Macaroni 

12.15 

12.82 

12.31 

2.77 

5.40 

74.58 
70.78 
75.16 
27.33 
87.18 

0.78 
0.74 
1.95 
0.07 
0.19 

340 

Vermicelli 

335 

Italian  Paste 

345 

Rice,  boiled 

119 

Tapioca 

350 

With  regard  to  the  question  of  allowing  old  people  tea,  coffee  or  cocoa, 
opinion  is  divided.  Coffee  and  tea  are  barred  by  some  authorities  as  pos- 
sessing no  food  value  and  as  containing  a  poisonous  principle — caffein, 
theobromin  and,  on  occasion,  a  considerable  amount  of  tannin.  They 
delay  digestion,  and  when  tannin  is  present  in  relatively  large  quantities 
they  tend  to  irritate  the  mucous  membrane  of  the  alimentary  tract.  They 
stimulate  to  some  extent  the  heart  and  nerve  centers.     Thus,  the  case 


450  DIET    m    PHYSIOLOGICAL   PERIODS 

against  the  use  of  such  beverages  for  the  old  would  seem  at  first  thought  to 
be  very  strong,  yet  when  we  look  at  the  other  side  of  the  mirror  and  con- 
sider that  the  drinking  of  tea  or  coffee  is  a  life-long  habit  and,  like  all 
habits,  hard  to  discontinue,  our  view  is  somewhat  modified.  However, 
there  are  many  harmful  habits  which  it  is  wise  and  expedient  to  break,  and 
if  it  were  proved  beyond  the  shadow  of  a  doubt  that  either  tea,  coffee  or 
cocoa  drinking  really  injured  old  people,  then  our  advice  would  be  not  to 
take  any  of  these  infusions  or  mixtures.  But  when  these  beverages,  are 
of  good  quality  (in  the  case  of  tea  that  variety  which  contains  the  least 
amount  of  tannin)  and  prepared  with  care,  we  are  of  the  opinion  that  the 
harm  done,  in  the  majority  of  instances,  is  counterbalanced  by  their  pleas- 
ure-giving physiological  effect.  They  are  indulgences,  it  is  true,  and 
stimulants  in  a  slight  degi-ee,  and  should  only  be  taken  in  strict  modera- 
tion by  those  elderly  people  who  have  been  accustomed  to  their  use  all 
their  lives,  and  who  suffer  no  inconvenience  from  their  use. 

The  condition  of  the  teeth. of  the  aged  is  a  matter  of  much  importance 
and  is  not  infrequently  responsible,  to  some  extent,  for  some  of  the  digest- 
ive troubles  from  which  they  suffer.  This  loss  or  partial  loss  of  the  me- 
chanical means  provided  to  man  for  masticating  his  food  is  regarded  in 
different  lights  by  different  authorities.  Sir  Henry  Thompson  is  of  the 
opinion  that  the  disappearance  of  the  masticating  powers  is  mostly  coinci- 
dent with  the  period  of  life  when  that  species  of  food  which  most  requires 
their  action — namely,  solid  animal  fiber — is  little  if  at  all  required  by  the 
individual.  It  is  during  the  latter  third  of  his  career  that  the  softer  and 
lighter  foods,  for  which  teeth  are  barely  necessary,  are  particularly  valu- 
able and  appropriate,  and  the  man  with  imperfect  teeth  who  conforms  to 
nature's  demand  for  a  mild  non-stimulating  dietary  in  advanced  years 
will  mostly  be  blessed  with  a  better  digestion  and  sounder  health  than  the 
man  who,  thanks  to  his  artificial  machinery,  can  eat  and  does  eat  as  much 
flesh  in  quantity  and  variety  as  he  did  in  the  days  of  his  youth. 

Campbell  takes  an  opposite  view.  He  points  out  that  people  who  have 
no  teeth  at  all  are  often  better  able  to  masticate  than  those  with  a  few  only, 
for  in  the  former  case  the  gums  are  allowed  to  come  together  and  harden, 
enabling  them  to  cope  with  many  kinds  of  food,  whereas  if  the  mouth 
is  furnished  with  teeth,  no  two  of  which  are  opposed,  they  are  useless  for 
purposes  of  mastication.  He  says  that  though  the  former  argument  seems 
plausible  enough,  prima  facie,  when  examined  critically,  it  will  be  found 
to  have  no  basis  in  fact.  If  senile  edentation  has  any  biological  meaning 
at  all,  it  indicates  not  that  nature  desires  a  return  to  the  diet  of  infancy, 
but  rather  that  the  time  has  come  to  cease  eating  altogether  and  to  lie  down 


DIET    IN    OLD    AGE  461 

and  die,  for  imder  natural  primitive  conditions  the  lack  of  teeth  implies 
death  from  starvation.  Consequently,  properly  fitting  teeth  cannot  but  be 
of  very  great  advantage  to  the  aged. 

The  latter  argument  seems  to  us  stronger  by  far  than  the  assertion  that 
because  in  old  age  teeth  come  out  it  signifies  that  they  are  no  longer 
needed.  Mastication,  if  not  so  essential  in  old  age  as  in  the  adult  period, 
is  yet  a  valuable  power  to  possess.  If  food,  carbohydrates  in  particular, 
is  not  masticated,  it  is  not  sufficiently  insalivated,  and  digestion,  thereof 
is  hindered  and  stomach  and  intestinal  troubles  are  certain  to  ensue. 
Moreover,  a  mainly  pap  diet,  consisting  largely  of  soft  starchy  food,  is  not 
the  kind  of  diet  to  suit  a  healthy  or,  indeed,  even  a  somewhat  feeble  old 
person  who  has  been  in  the  custom  of  eating  heartily  of  more  substantial 
fare.  We  agree  with  Campbell  that  thorough  mastication  is  good  for  the 
old,  for,  be  the  diet  mainly  protein  or  carbohydrate,  mastication  and  in- 
salivation  are  aids  to  proper  digestion  the  importance  of  which  can  scarcely 
be  overestimated.  We  agree,  too,  with  Thompson  (31)  that  the  old  do  not 
require  their  teeth  to  consume  as  much  animal  protein  as  they  were  accus- 
tomed to  when  in  full  vigor  of  manhood,  for  they  most  assuredly  need,  as 
a  rule,  but  a  limited  amount  of  animal  food.  Campbell,  however,  is  in 
favor  of  a  simple  diet  with  not  a  large  amount  of  animal  protein  through- 
out life,  and  indeed  sees  no  reason  to  differ  the  dietary  of  healthy  old  age 
and  adult  life  to  any  great  extent. 

The  consumption  of  meat  in  old  age  is  still  in  some  degree  a  mooted 
question.  There  are  many  of  the  opinion  of  Sir  Henry  Thompson, 
who  hold  that  at  any  period  of  life  the  use  of  meat  should  be 
limited,  and  others,  like  Campbell,  who  believe  that  to  be  full  fed 
throughout  life  is  in  the  best  interests  of  good  health.  There  are  yet 
others,  like  Woodruff,  who  think  that  no  particular  stint  of  animal 
food  is  necessary.  As  a  matter  of  fact,  it  is  impossible  and  would  be  pre- 
sumptuous to  lay  down  any  rigid  rules  of  diet  in  order  to  prolong  life. 
Heredity  is  one  of  the  most  important  factors  in  the  attainment  of  this 
consummation,  while  diet  undoubtedly  is  of  the  first  significance  and  of 
special  import  in  advanced  age.  Scientific  investigations  and  observations 
and  practical  experience  have  both  taught  that  less  food  is  needed  after  a 
certain  age  has  been  reached  and  that  the  ingestion  of  meat  should  be 
diminished.  Nevertheless,  a  great  deal  depends  on  what  kind  of  life  is 
led.  If  active  and  fairly  strenuous,  a  person,  although  old,  requires  a  suf- 
ficiently generous  amount  of  food,  and  if  he  is  accustomed  to  eating  meat, 
the  amount  should  not  be  unduly  restricted.  In  most  cases  it  is  advisable 
to  reduce  the  amount  of  animal  food  to  one-Tialf  of  that  consumed  by  people 


452  DIET    IN    PHYSIOLOGICAL    PERIODS 

in  middle  life.  Certain  it  is  that,  if  arteriosclerosis  has  made  much  head- 
way, very  little  meat  should  be  eaten.  Allbutt  says  on  this  point  that  the 
sum  of  the  argument  is,  so  far  as  butcher's  meat  and  arteriosclerosis  are 
concerned,  that  certain  observations  which  we  owe  to  Abelous  and  others 
offer  evidence  with  some  clearness  to  show  that  one  or  two  definite  and 
separable  crystalline  products  produced  by  bacteria,  especially  by  a  specific 
bacillus  of  the  colon  group,  can  affect  the  blood  pressure. 

Dietetic  restrictions  are  obviously  indicated  in  the  bronchitis  of  the 
aged.  Many  of  such  patients  are  allowed  to  die  through  carelessness  in 
diet.  As  Campbell  shows  it  is  not  merely  that  overeating  begets  bron- 
chitis. The  bronchitis  and  the  emphysema  that  goes  along  with  it  curtail 
the  respiratory  capacity,  and  so  prevent  the  excess  of  food  from  being 
burned  off.  In  fact,  the  only  hope  of  saving  the  obese  bronchitic  patient 
is  by  a  systematic  semistarvation. 

Campbell  (30)  thinks  that  for  elderly  and  aged  gourmands  it  is  gen- 
erally even  more  necessary  to  cut  down  the  allowance  of  starch  and  sugar 
than  animal  food,  although  this  should  also  be  curtailed  if  excessive.  All 
appear  to  be  agreed  that  alcohol  in  any  form  is  of  little  value  in  the  diet 
of  the  aged,  and  should  never  be  taken  when  a  high  blood  pressure  exists. 

The  warding  off  of  old  age,  and  more  particularly  the  warding  off  of 
premature  old  age,  can  perhaps  in  the  majority  of  cases  be  effected  by  care- 
ful diet.  But  it  must  ever  be  remembered  that  as  there  are  all  sorts  and 
conditions  of  men,  so  there  are  all  sorts  and  conditions  of  constitutions  and 
idiosyncrasies.  Some,  whether  they  eat  sparingly  or  profusely,  suffer 
from  digestive  troubles  and  are  apt  to  grow  old  prematurely.  They  are 
bad  metabolizers.  This  class  is  not  a  very  large  one,  and  even  with  them 
life  may  be  prolonged  by  paying  extreme  attention  to  their  alimentation. 
Again  there  are  those  who  possess  sensitive  stomachs  and  whose  digestive 
processes  are  easily  upset,  albeit  they  may  be  sound  in  constitution.  These 
are  generally  persons  of  nervous  temperament,  who,  if  they  exercise  care 
in  their  dietetic  regimen,  may  live  to  be  very  old.  This  type,  like  creak- 
ing gates,  lasts  longest.  Then  there  are  the  hale  and  hearty  individuals 
who  by  reason  of  their  robustness  and  strong  digestive  and  assimilative 
powers,  eat  and  drink  to  excess,  and  who  frequently  by  so  doing  bring 
their  lives  to  an  abrupt  end.  As  a  rule,  the  moderate  eaters  and  drinkers 
live  the  longest. 

Yeo(32)  gives  the  following  useful  suggestions  in  regard  to  the  diet  of 
the  aged : 

Any  sudden  changes  in  diet  should  be  avoided,  and  the  intervals  between  the 
ingestion  of  food  should  not  exceed  six  or  eight  hours. 


DIET    IN    OLD    AGE  453 

It  is  very  common  for  elderly  people  to  awaken  early  in  the  morning,  at  three 
or  four  o'clock,  and  to  be  unable  to  drop  off  to  sleep  again,  but  if  they  have  some 
light  form  of  nourishment  at  the  bedside,  such  as  a  glass  of  milk  or  a  little  gruel, 
which  they  can  take  at  that  time,  they  will  often  continue  their  sleep. 

Tlie  acidity  of  certain  stewed  fruits  may  be  advantageously  neutralized  by 
the  addition  of  a  little  bicarbonate  of  soda,  so  as  to  avoid  the  use  of  a  large 
quantity  of  cane  sugar,  as  this  is  apt  to  cause  gastric  fermentation  and  acidity. 
In  stewing  fruit,  about  as  much  soda  as  will  cover  a  shilling  should  be  added  to 
each  pound  of  fruit. 

Aged  persons  often  require  their  food  to  be  accompanied  with  some  kind  of 
condiment,  which  promotes  their  digestion  and  prevents  flatulence.  Caviare  and 
the  roes  of  smoked  and  salted  herrings  are  of  this  nature. 

For  sweetening  food,  milk  sugar  is  much  less  prone  to  excite  acid  fermentation 
than  cane  sugar. 

A  very  digestible  form  of  fat — when  it  is  needed — is  cream,  mixed  with  an 
equal  quantity  of  hot  water  and  about  ten  drops  of  sal  volatile  to  each  fluid  ounce. 

EEFEKENCES 

1.  Staer,  M.  Allen.    Diseases  of  Infancy  and  Childhood. 

2.  Watson.    Foods  and  Feeding. 

3.  Hall,  WiNFiELD  S.    Nutrition  and  Dietetics. 

4.  Fitch,  W.  E.     Rations  for  Young  Boys'  Military  Training  Camp, 

Mil.  Surgeon,  April,  1917. 

5.  Gephart.     Russell  Sage  Institute  of  Pathology;  Editorial,  J.  Am. 

Med.  Assn. 

6.  LusK,  Graham.     Food  Economics,  J.,  Washington  Academy  of  Sci- 

ence, 1916,  vol.  vi,  p.  390. 

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&  Co.,  1913. 

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10.  Prochownick.     Zentralbl.  f.  Gynak.,  1899,  p.  33. 

11.  Edgar,  J.  C.     Practical  Obstetrics,  pub.  by  Blakiston,  5th  ed. 

12.  Gautier.     Diet  and  Dietetics. 

13.  Rotch,  T.  M.    American  Text-book  of  Pediatrics,  W.  B.  Saunders, 

Philadelphia. 

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London,  1915. 

18.  Allbutt.     System  of  Medicine. 
129 


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toii,  1916. 

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22.  VoiT.     Zschr.  f.  Biol.,  1876,  p.  32. 

23.  Maurel.     Rev.  Soc.  scient.  d'hyg.  aliment.,  1906,  p.  Y63. 

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27.  MuNK  and  Ewald.     Diseases  of  the  Stomach. 

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CHAPTEK    XIV 


HYGIENE    OF    THE    INTESTINES 


William  P.  Cunningham,  A.M.,  M.D. 


General  Considerations. 

Chronic   Intestinal   Stasis;     Diseases   Due   to   Chronic  Intestinal   Stasis; 

Considerations  of  Diet  in  Chronic  Intestinal  Stasis;  Hygiene  of  the 

Intestinal  Canal. 

GENERAL    CONSIDERATIONS 

The  subject  of  this  chapter  has  a  great  deal  broader  scope  than  would 
appear  upon  cursory  examination.  The  hygiene  of  the  intestinal  tract 
has  a  deeper  significance  than  the  relief  of  certain  local  disturbances,  de- 
pendent upon  the  imperfect  evacuation  of  the  lower  segment.  It  has  to 
do  with  problems  of  a  grave  and  far-reaching  character.  To  appreciate 
this,  it  will  be  necessary  to  recall  the  construction  of  the  abdominal  viscera 
with  especial  reference  to  the  matter  of  drainage. 

We  shall  content  ourselves  by  simply  recalling  that  the  human  being 
is  a  hollow  organism  from  the  mouth  to  the  anus.  There  exists,  then,  a 
continuous  membranous  tube  with  dilatations  and  constrictions  demanded 
by  the  exigencies  of  the  situation.  The  pharynx,  the  esophagus,  the  stom- 
ach, the  small  and  the  large  intestine  vary  in  size,  but  constitute  one  con- 
tinuous canal.  Anything  that  enters  at  the  mouth,  must  exit  at  the  anus 
unless  absorbed  in  transit.  It  is  obvious  that  for  the  proper  functioning 
of  such  a  tubular  organ,  there  must  be  an  unobstructed  right  of  way.  Any 
unusual  constriction  anywhere  in  its  course  may  convert  it  into  "no  thor- 
oughfare" and  induce  a  train  of  consequences  of  the  most  surprising  and 
deplorable  kind.  The  numberless  evil  things  that  accumulate  in  the  prog- 
ress of  a  more  or  less  thoroughly  digested  mixture  from  the  stomach  to 
the  rectum,  may  be  detained  by  abnormalities  of  the  channel,  until  they 
have  accomplished  various  toxic  reactions  and  been  absorbed  into  the  gen- 
eral circulation.    Locally  also  they  produce  irritations  of  a  serious  nature. 

455 


456 


HYGIENE    OF    THE    INTESTINES 


An  uninterrupted  fair  way  would  in  all  likelihood  have  been  main- 
tained had  man  not  risen  from  the  posture  for  which  he  had  originally 
been  designed.  Going  on  all  fours,  his  intestines  swung  free  from  their 
mesenteric  attachments  to  his  spine.  There  was  no  danger  of  kinking, 
fouling  or  jamming  of  the  various  loops.  The  chylous  tide  swept  on  with 
perfect  freedom  to  its  destination.  But  when  in  the  assumption  of  his 
new-found  dignity  he  proudly  drew  himself  erect,  the  relation  of  the  gut 
to  its  attachments  was  entirely  altered.  It  now  dragged  upon  a  mesentery 
clinging  to  a  perpendicular  support  and  was  thrown  into  unpremeditated 
disarray.     It  sustained  "strained  relations"  with  its  environment. 

As  the  advance  of  man  in  the  refinements  of  civilization  entailed  in- 
creasing impairment  of  the  muscular  energy  of  his  aboriginal  forbears,  he 
began  to  experience  the  inevitable  results  of  the  faulty  position  of  his  ab- 
dominal contents.  Debility,  disease,  corsets,  gluttony,  sloth,  obesity, 
caused  the  prolapse  of  the  imperfectly  secured  intestines,  and  they  sagged 
into  feeble  pouches,  incapable  of  adequate  peristalsis,  and  making  a  con- 
stant traction  on  the  contiguous  sections.  Nature,  ever  conservative, 
strove  to  offset  this  injurious  derangement  by  passing  supporting  bands 
under  the  dragging  loops.  As  frequently  happens,  nature  overreached  her- 
self.    The  new  supports  became  added  elements  of  danger  and  distress. 

The  weight  of  the  prolapsed 
portion  caused  an  angular 
distortion  at  the  site  of  the 
supplementary  slings,  for 
all  the  world  as  if  one  hung 
an  empty  hose  over  a  fence. 
Against  this  added  obstruc- 
tion the  already  fatigued 
intestine  struggled  with  di- 
minishing success.  The  ac- 
cumulation behind  the  ob- 
struction steadily  increased, 
while  the  gut  in  front  was 
empty  and  collapsed.  Here 
was  established  what  Sir 
Arbuthnot  Lane  has  so 
aptly  termed  a  cesspool,  and 
in  til  at  cesspool  are  gen- 
erated, as  in  the  most  pro- 
ductive culture  medium,  a 


Fig. 


6. — Case  X.  Inflammatory,  Supebimposed 
UPON  EvoLUTioxABY  Stasis.  Lane's  band, 
with  potential  kinlc;  prolapsed  transverse 
colon,  ascending  colon,  and  sigmoid;  Jon- 
nesco's  fold;  Jackson's  membrane.  Three  sets 
of  firm  fibrous  bands,  just  below  ileocecal 
valve,  extend  from  ileum  to  right  iliac  fossa, 
one  to  right  ovarv. 


GENERAL    CONSIDERATIONS 


457 


host  of  microbial  invaders  whose  varied  activities  are  responsible  for 
most  of  the  ills  that  flesh  is  heir  to.  This  is  no  overdrawn  or  fanciful 
picture.  It  is  a  plain  statement  of  truth  susceptible  of  the  completest 
corroboration. 

No  fact  in  medical  practice  is  of  more  ancient  usage  than  the  effort 
to  overcome  constipation.  The  evil  of  the  inactive  bowel  has  ever  been 
recognized.  "Make  a  hole  through"  was  the  homely  dictum  of  the  old 
schoolmen.  In  this  injunction  they  epitomized  the  whole  question  of  in- 
testinal stasis  and  adequate  drainage.  They  did  not  comprehend  the 
causes  at  work  in  preventing  this  essential  function.  They  attributed  to 
many  agencies,  conditions  which  we  have  found  largely  confined  to  one. 
They  talked  of  diet  and  torpid  liver  and  insufficient  exercise  and  defective 
innervation,  and  they  some- 
times cured  a  case  where  such 
factors  had  brought  about  a 
fecal  blockade  in  the  rectum. 
But  they  realized  that  the 
failure  of  the  bowel  to  empty 
itself  created  si  pathological 
situation  of  serious  import 
which  demanded  all  their  sci- 
ence to  remove.  It  consti- 
tuted the  stopping  of  a  sewer 
with  a  backing  up  of  its  dele- 
terious contents.  No  discrim- 
ination was  made  between  the 
massing  of  dried  effete  detritus 
of  a  comparatively  harmless 
character  in  the  part  of  the. 
tract  least  provided  with  ab- 
sorbents, and  a  fluid  compound  of  putrescent  material  stagnant  at  the 
gaping  mouths  of  numberless  lymphatics.  The  lower  bowel  could  be 
emptied ;  its  repacking  could  be  prevented.  Diet,  exercise  and  laxatives 
were  all-sufficient  here.  Just  a  little  care  and  watchfulness  achieved  the 
desired  result  and  made  the  reputation  of  some  wonderful  cathartic. 

But  of  the  organic  barrier  above,  of  the  angular  kink,  of  the  saccu- 
lated cesspool,  they  had  no  glimmering,  and  consequently  could  not  intelli- 
gently direct  their  therapeutic  fire.  It  remained  for  the  adventurous 
English  surgeon.  Sir  Arbuthnot  Lane,  to  discover  the  obstructing  abnor- 
mality, and  boldly  proclaim  it  to  a  skeptical  profession.     So  ill  was  his 


Fig.  7. — E.  B.,  Female,  30,  Single.  Lane's  band; 
ileal  stasis;  appendix  and  ovary  caught  in 
band;  caeeura  dilated. 


458 


HYGIENE    OF    THE    mXESTINES 


evangel  received  by  rock-ribbed  conservatism  that  he  was  hooted  out  of  his 
scientific  societies.  He  was  thrnst  outside  the  breastworks  by  his  English 
confreres,  and  stigmatized  as  something  uncainiy  and  unclean.  It  was 
only  when  he  appealed  to  the  surgeons  of  America  that  he  began  to  make 
impression  on  the  general  incredulity.  He  proved  his  case  and  the  repute 
of  his  success  traveling  back  to  the  slower  innovators  at  home,  rehabili- 
tated him  in  the  good  opinion  of  his  own  people.  The  doubt,  reproach 
and  derision  with  which  he  had  been  originally  received  gave  place  to 
confidence  and  respect. 


CHRONIC   INTESTINAL   STASIS 

Chronic  intestinal  stasis  due  to  mechanical  obstruction  was  firmly 
planted  in  the  pathology  of  advanced  medical  thought.  Not  that  all  oppo- 
sition to  the  idea  has  been 
overcome.  While  man  has 
power  of  cerebration,  differ- 
ences of  opinion  will  persist. 
It  is  impossible  to  break 
down  the  adamantine  resist- 
ance of  prejudice  and  con- 
ceit. Both  will  hold  out 
against  the  plainest  evidence 
of  their  erroneous  attitude. 
But  men  of  ordinary  sober 
judgment,  comprising  as  they 
do  the  great  majority  of  our 
confraternity,  are  susceptible 
to  conviction  and  ready  to 
yield  assent  upon  presenta- 
tion of  the  facts  of  the  case. 
So  while  we  occasionally  hear  a  protesting  note  from  some  lofty  pin- 
nacle, while  some  eagle  flaps  his  wings  and  declines  to  see  anything  but 
his  own  reflection  in  the  sun,  while  some  bird  of  lesser  quality  croaks 
his  envious  disapprobation,  the  dissonance  is  swallowed  in  the  chorus  of 
approval  arising  from  the  level-headed  searchers  after  truth.  True  to 
its  etymology,  stasis  has  come  to  stay;  we  mean  only  in  the  etiological 
sense  and  not  in  the  sense  of  an  incurable  condition. 

In  order  to  intelligently  treat  an  anatomical  distortion  of  this  charac- 
ter, thus  mischievously  situated,  it  is  incumbent  to  grasp  clearly  not  only 


Fi(i 


8. — J.  S.  Chronic  Intestinal  Stasis,  with 
Veby  Broad  Band  Angulating  Duodeno- 
jejunal Junction.  Dilated  duodenum ;  band 
angulating  duodeno-jejunal  junction;  col- 
lapsed jejunum. 


CHRONIC    INTESTINAL    STASIS 


459 


all  the  demonstrated  eonseqiieuees  but  also  the  inferential  and  rationally 
deducible  conclusions  in  the  premises.  Before  we  may  suggest  measures 
of  relief,  we  must  be  able  to  show  wherein  the  economy  is  at  fault.  Hav- 
ing established  the  fact  of  chronic  intestinal  stasis,  it  was  necessary  to 
associate  it  with  degrees  of  disability  and  danger  sufficient  to  warrant  rad- 
ical interference.  This  has  been  accomplished.  It  is  maintained  by  emi- 
nent authorities  that  intestinal  putrefaction  conduces  to  brevity  of  exist- 
ence. Where  actual  disease  is  produced  thereby,  this  is  undeniable. 
Where  no  such  disease  is  definable,  we  must  rely  upon  our  reason  to  sup- 
ply the  explanation. 

It  is  unquestionable  that  the  constant  absorption  of  poisonous  elements 
into  the  general  system  must  put  upon  it  a  Sisyphus'  task  of  elimination. 
This  taxes  the  arterial  capacity  to  the 
utmost.  The  vessels  are  working  at 
high  pressure  all  the  time  and  eventu- 
ally undergo  permanent  changes  for  the 
effectual  performance  of  the  exaggerated 
function.  The  kidneys  respond  to  the 
increased  demands  of  the  throbbing  ar- 
teries by  a  temporarily  raised  efficiency, 
which  is  followed  as  a  matter  of  course 
by  a  steadily  growing  deficiency  and 
a  speedy  termination  of  the  career  of 
the  organism.  This  is  deduction,  and 
seems  to  be  borne  out  by  numerous 
observations. 

We  are  quite  persuaded  also  thai 
many  of  the  maladies  for  which  we  have 
no  satisfactory  etiology  can  be  traced  to 
the  pestilential  puddle  in  the  sacculated 
gut.  No  man  knows  the  extent  of  the 
chemical  combinations  therein  effected. 
All  the  circumstances  are  favorable  for 

the  unimpeded  development  of  deleterious  bacteria  and  alkaloidal  poisons 
of  variable  virulence.  Shortly  after  eating  clams,  men  have  died  with 
symptoms  of  acute  toxemia.  Here  the  poison  was  undoubtedly  introduced 
with  the  clams.  But  such  an  article  eaten  fresh  and  coming  partly  digested 
into  a  prolapsed,  distended  and  disabled  intestine  (to  fester  and  rot  in 
the  heat  and  moisture),  would  be  perfectly  capable  of  achieving  the  same 
appalling  result.    Steadily  surging  forward  through  an  unobstructed  chan- 


FiG.  9. — C.  O.  Ghroxic  Intestinal 
Stasis,  with  Mabked  DroDENO-JE- 
JUNAL  Kink,  Causing  Distention 
OF  Duodenum.  Bands,  causing  duo- 
deno-jejunal  kink;  jejunum;  stom- 
ach; dilated  duodenum. 


460  HYGIENE    OF    THE    INTESTINES 

nel,  the  putrefiable  matter  would  have  quickly  reached  a  region  where 
absorption  was  tardy  and  the  danger  practically  negligible.  The  plumbers 
put  ''traps"  in  the  course  of  their  waste  pipes  to  prevent  the  ascent  of 
poisonous  gases  from  the  sewer.  This  word  might  be  fairly  applied  to  the 
fallen  sections  of  hollow  viscera  constituting  the  pathology  of  stasis.  They 
are  veritable  ''traps"  for  the  retention  of  the  deadly  excrement  seeking 
an  avenue  of  escape.  This  slight  play  upon  words  will  serve  to  impress 
the  real  conditions  back  of  most  of  the  cases  of  intestinal  putrefaction.  It 
is  doubtful  whether  putrefaction  of  any  considerable  degree  could  take 
place  in  an  intestine  operating  with  unhindered  peristalsis.  Nature  is 
able  to  take  care  of  much  excessive  material  if  she  is  not  crippled  or  de- 
formed. 

Diseases  Due  to  Chronic  Intestinal  Stasis. — The  great  English  surgeon 
who  blazed  the  trail  that  has  brought  us  to  such  a  land  of  hope  and  prom- 
ise, claimed  to  have  proved  the  causation  of  many  grave  affections  in  the 
toxic  reactions  of  the  delayed  ileal  effluent.  Diabetes  mellitus,  rheumatoid 
arthritis,  tuberculosis,  epilepsy,  ulcerative  endocarditis,  nephritis,  pyelitis, 
cystitis,  salpingitis,  cholecystitis,  Raynaud's  disease  and  cancer  of  the  in- 
testines are  all  the  direct  or  indirect  result  of  mechanical  interference 
with  body  drainage.  This  is  a  fearsome  list  and  a  bold  challenge!  But 
the  quality  of  its  sponsor  should  curb  the  tongue  of  impetuous  distrust. 
Men  of  that  stamp  do  not  idly  maintain  untenable  opinions.  They  speak 
with  conviction.  The  presence  of  a  low-grade  inflammatory  focus  near 
the  head  of  the  pancreas,  permeated  with  bacteria  and  sodden  with  toxins, 
supplies  a  plausible  explanation  of  the  disturbance  of  that  associated  organ 
in  our  conception  of  the  pathogenesis  of  diabetes.  In  view  of  the  inade- 
quacy of  every  other  hypothesis,  it  is  judicious  to  accord  this  one  careful 
consideration.  Operation  has  resulted  favorably  in  this  notoriously  un- 
promising metabolic  anomaly. 

RHEUMATOID  ARTHRITIS. — Rheumatoid  arthritis,  inexorable  as  fate 
in  the  cumulative  crippling  of  its  miserable  victim,  has  baffled  the  pa- 
tience and  ingenuity  of  our  ablest  investigators.  Etiology  and  therapeu- 
tics alike  have  been  barren.  Absurdity  has  distinguished  some  of  the 
suggestions  offered.  This  is  likely  to  happen  in  conditions  of  great  ob- 
scurity. So  little  light  is  available  that  any  flicker  is  noticeable.  Even 
Riggs'  disease  has  had  its  passing  vogue  in  this  etiological  relation.  But 
now  comes  Lane  with  a  causative  factor  big  enough  to  fit  the  conditions. 
Instead  of  a  few  bacteria  emerging  from  the  depths  of  an  alveolar  abscess, 
and  furnishing  to  the  imagination  an  altogether  insufficient  explanation 
of  such  tremendous  consequences,  we  are  asked  to  observe  a  mighty  incu- 


CHRONIC    INTESTINAL    STASIS  461 

bator  reeking  with  the  pestilential  products  of  decomposing  nitrogenized 
compounds.  Here  is  a  source  worthy  of  respectful  attention.  It  is  obvi- 
ous that  here  could  originate  any  conceivable  assault,  no  matter  how 
deadly,  upon  the  integrity  of  the  organism.  Our  sense  of  proportion  is 
satisfied,  and  when  by  brilliant  surgical  intervention  the  progress  of  the 
disease  is  halted  and  ankylosis  limbers  up,  we  are  confronted  with  a  situ- 
ation summarized  in  the  wise  old  aphorism  about  the  proof  of  the  pudding 
being  in  the  eating.  The  startling  improvement  in  cases  of  epilepsy 
treated  with  reference  to  intestinal  incitation  is  a  remarkable  testimonial 
to  the  genius  of  men  who  have  had  the  courage  of  their  unusual  convic- 
tions. 

ULCER  OF  THE  STOMACH  AND  DUODENUM.— Ulcer  of  the  stomach 
and  duodenum  is  doubtless  due  to  the  irritation  resulting  from  angular 
obstruction  of  the  latter  by  the  downward  pull  of  the  rest  of  the  small  in- 
testine. The  stomach  becomes  secondarily  dilated  from  the  constant  py- 
loric contraction  maintained  to  resist  the  regurgitation  of  the  duodenal 
contents.  Present  now  are  the  factors  favorable  to  the  development  of 
cancer;  local  irritation;  local  interference  with  circulation;  the  swarming 
microbes  indigenous  to  decomposing  tissue.  Infection  of  the  gall  bladder 
and  liver  may  take  place  through  their  ducts,  and  so-called  primary  can- 
cer of  the  liver  may  be  a  consequence  of  this  invasion. 

The  appendix  may  be  involved  in  the  band  extending  from  the  cecuTn 
upwards  and  outwards  and  producing  a  kink  or  some  other  obstruction  to 
its  lumen.  The  appendix  may  be  otherwise  affected  by  its  fixation, 
through  acquired  bands,  to  the  under  surface  of  the  ileum.  The  large 
bowel  may  be  attached  on  the  left  side  to  the  pelvic  brim,  greatly  impeding 
the  descent  of  fecal  matter.  The  false  membrane  here  may  enclose  the  left 
ovary,  with  the  ultimate  result  of  a  cystic  tumor.  In  short,  adventitious 
bands  may  appear  at  any  point  demanding  additional  support  and  may 
interfere  in  many  ways  with  the  activity  of  the  whole  tract,  or  may  exert 
damaging  pressure  on  structures  in  their  neighborhood.  The  serious  con- 
sequences sometimes  attendant  on  the  position  of  these  bands  have  been 
rapidly  recited.  Others  less  menacing  but  nevertheless  trying  and  objec- 
tionable extend  the  evil  influence  of  this  abnormality  to  an  immense 
degree. 

The  ductless  glands  are  coming  into  their  own  as  important  factors  in 
the  elucidation  of  many  physical  disorders.  We  have  long  known  of  the 
affection  of  the  thyroid  and  the  suprarenals.  We  are  familiar  with  ex- 
ophthalmic goiter  and  myxedema.  We  are  as  well  acquainted  with  Addi- 
son's disease  and  its  tell-tale  bronzing  of  the  skin,  but  we  could  not  here- 


462 


HYGIENE    OF    THE    INTESTINES 


tofore  account  for  the  perversion  of  glandular  activity.  We  are  acquiring 
illuminating  information  with  regard  to  the  attributes  of  the  pituitary, 
the  thymus,  the  testis  and  the  ovary.  We  perceive  that  many  disturb- 
ances of  metabolism  are  connected  with  their  derangement,  but  that  is 
only  a  partial  solution  of  the  problem  presented,  for  what  is  responsible 

for  the  derangement? 
Lane  has  succeeded  in 
associating  degenera- 
tion of  the  thyroid 
with  chronic  intestinal 
stasis  and  has  made 
out  a  very  reasonable 
case  in  the  matter  of 
the  suprarenals.  It  is 
fully  in  accord  with 
the  best  thought  of 
modern  medicine  that 
these    ductless    glands 

Fig.  10. — Case  V.     Dilated  ileum  proximal  to  Lane's  band;    glioiikl  suffer  from  mi- 
Lane's    band;     ileopelvic    band;     aneulated    appendix  i  •      •  •  i 

, ,  .    ,      ,     T    1       »  I  crobic  incursions ;  and 

caught  in  band;   Jackson  s  membrane.  ' 

where  should  be  the 
most  likely  breeding  place  but  this  very  cessjDool  seething  within  the 
patient's  abdomen  ? 

EFFECT  OF  STASIS  ON  THE  INTERNAL  SECRETIONS.— The  study  of  the 
internal  secretion  is  progressing  with  great  diligence  and  success  and  we 
may  expect  to  find  therein  the  explanation  of  many  perplexities.  But 
hand  in  hand  should  go  the  inquiry  into  the  state  of  the  internal  secre- 
tions as  the  cause  of  disease,  dyscrasia  or  disorder,  and  as  the  pathological 
consequences  of  a  previously  existing  infection.  The  last  word  has  not 
been  said  when  we  cry  out  "internal  secretions."  We  may  show  them  as 
the  cause  of  acromegaly  and  scleroderma  and  osteomalacia,  and  a  growing 
list  of  obscure  maladies,  but  only  a  part  of  the  work  is  done;  we  must 
link  them  with  the  reason  of  their  seemingly  erratic  action,  Feeding 
pituitary  extract  will  be  incomplete  and  indecisive  therapeusis  compared 
with  the  removal  of  the  glandular  irritant.  The  dermatoses  dependent 
upon  or  aggravated  by  intestinal  putrefaction  are  many  and  various.  It 
is  generally  conceded  that  any  retardation  of  peristaltic  action  tends  to  the 
development  of  acne,  eczema,  urticaria,  toxic  erythema,  erythema  multi- 
forme, bromidrosis  and  pruritus.  The  foul  breath,  apathy,  headache  and 
sallowness  establish  the  identity  of  the  suspected  agency.     The  sweeping 


CHROOTC    I:N^TESTINAL    stasis  463 

out  of  the  bowels,  if  complete,  has  a  pronoimced  effect  upon  the  cutaneous 
manifestations.  But  frequently  the  most  vigorous  campaign  will  fail  to 
give  us  satisfactory  evacuations,  and  the  skin  will  resist  our  most  intensive 
medication.  Here  we  have  to  deal  undoubtedly  with  a  blocking  of  the  in- 
testinal lumen  by  mechanical  obstacles.  The  cathartics  are  unable  to 
force  the  straits  and  the  stretched  and  straining  gut  retains  its  poisonous 
fecundity. 

ACIDOSIS. — The  interpolation  of  acidosis  adds  a  word  to  the  etiological 
hypothesis  without  detracting  from  its  credibility.  We  accept  the  fact  of 
acidosis  just  as  we  accept  the  fact  of  the  internal  secretions.  It  may  be 
admitted  that  the  skin  eruptions  enumerated  above  are  fairly  attributable 
to  acidosis.  It  is  certain  that  alkalies  play  a  large  part  in  the  reputedly 
effective  medical  treatment,  but  acidosis  is  a  terminal  or  intermediate  con- 
dition, and  invariably  dependent  on  some  other  disturbing  factor.  Acido- 
sis kills  the  victim  of  diabetes,  but  it  does  not  constitute  nor  originate  dia- 
betes. All  toxemias  include  an  acidosis,  hence  the  transition  is  easy  from 
intestinal  putrefaction  to  acidosis;  to  irritative  skin  diseases. 

CUTANEOUS  LESIONS. — There  are  many  cutaneous  lesions  to  which  we 
have  no  etiological  clue.  Most  of  them  are  due  to  circulatory  disturb- 
ances. I^ote  the  cold  and  waxy  fingers  of  the  "bilious"  crisis.  The  lag- 
gard gut  is  responsible  for  them.  How  far  a  cry  is  it  from  an  acute  claudi- 
cation to  a  chronic  claudication  and  the  establishment  of  Raynaud's  dis- 
ease ?  Circulatory  anomalies  underlie  scleroderma.  With  or  without  the 
intervention  of  the  pituitary  gland,  the  infiltration  may  be  ascribed  to  the 
same  agency  as  Raynaud's  disease.  Of  infinite  variety  are  the  germs  of 
intestinal  origin.  Of  infinite  variety  are  the  toxins  there  elaborated.  How 
various,  then,  may  be  the  manifestations  in  the  skin  or  otherwise  of 
their  vicious  versatility ! 

A  normal  individual  gives  no  more  heed  to  his  intestinal  canal  than 
to  respond  to  impulses  for  evacuation.  There  is  no  question  of  hygiene 
involved  in  such  a  case.  The  management  of  the  bowel  comes  into  debate 
only  when  it  is  manifestly  unable  to  manage  itself.  We  are  all  taught  the 
detriment  of  chronic  constipation.  Hence,  many  of  the  results  of  chronic 
intestinal  stasis  are  forestalled  by  the  persistent  efforts  made  to  overcome 
this  conspicuous  symptom.  This  is  part  of  the  hygiene  of  the  intestinal 
canal,  and  obviously  a  most  important  part.  If  the  drainage  from  the 
whole  tract  can  be  effectually  maintained,  then,  despite  the  narrowing  at 
any  point,  constitutional  disturbance  will  be  avoided.  This  is  the  pivot 
on  which  revolves  the  whole  discussion  of  intestinal  stasis.  If  there  is 
adequate  drainage  there  is  no  stasis.     If  there  is  stasis  there  cannot  be 


464  HYGIENE    OF    THE    INTESTI:N'ES 

adequate  drainage.  Adventitious  bauds  may  exist  without  choking  the 
channel  to  a  serious  degree,  and  passage  is  maintained  for  the  excrementi- 
tious  tide.  This  is  a  fortunate  conjunction  of  circumstances.  If  the  pres- 
sure is  slightly  increased  and  the  channel  is  a  little  further  contracted, 
there  will  be  sufficient  slowing  of  the  aforesaid  tide  to  constitute  a  patho- 
logical state.  There  may  be  colicky  pains  and  headache  and  perhaps 
vomiting;  the  well-known  "bilious"  attack.  Cathartics  usually  prove  suf- 
ficient correctives  for  the  occasion.  If  sanely  administered  in  advance, 
they  may  prevent  much  of  the  mischief. 

Considerations  of  Diet  in  Intestinal  Stasis. — Here  is  a  condition  where 
Dr.  A.  Everett  Austin's  masterly  chapter  on  "Diet  in  Intestinal  Stasis" 
will  apply  with  peculiar  aptness.  The  regulation  of  the  diet  along  the 
lines  of  reducing  bulky  detritus  and  avoiding  undue  flatulence  will  con- 
tribute markedly  to  the  well-being  of  the  patient.  Attacks  will  certainly 
be  less  frequent  and  more  readily  controlled.  Apertures  patulous  to  the 
passage  of  fluids  become  occluded  by  undigested  masses  such  as  fruit  skins, 
lettuce  leaves,  nuts  and  slow-melting  fats.  Apertures  competent  under 
ordinary  conditions  may  be  occluded  by  the  ballooning  of  the  adjacent 
bowel  with  gas.  The  constriction  is  increased  by  the  impediment  to  the 
venous  circulation  and  the  swelling  of  the  tissues. 

A  happy  termination  of  such  a  threatening  episode  is  favored  by  total 
abstinence  from  food  and  the  administration  of  brandy  and  ice  as  indi- 
cated for  thirst  and  exhaustion.  Situations  fraught  with  such  imminent 
possibilities  of  disaster,  where  sudden  total  obstruction  may  occur  upon 
the  slightest  deviation  from  a  rigid  regimen,  where  the  inclination  to 
safety  or  peril  is  poised  upon  the  most  delicate  balance,  belong  properly 
to  the  province  of  surgery.  A  section  of  drain-pipe  in  a  house  continually 
getting  out  of  order  through  the  inadequacy  of  its  bore,  would  not  be  judi- 
ciously handled  by  seeing  that  only  the  thinnest  fluids  were  allowed  to 
enter  it.  The  plumber  would  be  called  in  and  a  new  section  substituted. 
So  should  it  be  with  the  plumbing  of  the  human  body.  The  intestines 
in  addition  to  being  organs  of  digestion  are  drain-pipes  for  refuse.  In- 
adequacy of  bore  can  be  met  only  by  enlarging  the  bore.  Other  methods 
of  relief  are  temporary  makeshifts  trifling  with  the  danger. 

Surgery  does  not  always  mean  the  knife.  Orthopedic  surgery  often 
operates  with  bloodless  manipulation.  As  already  explained,  the  incom- 
petency of  the  canal  in  these  intestinal  conditions  may  be  due  to  the  sag- 
ging of  prolapsed  portions  over  new-formed  bands.  The  raising  of  these 
portions  may  be  followed  by  a  straightening  of  the  angular  deformity  and 
the  enlarging  of  the  opening.    A  properly  fitting  belt  with  spring  support 


CHRONIC    INTESTINAL    STASIS 


465 


pressing  on  the  abdomen  below  the  umbilicus  is  sometimes  effectual  in 
cases  of  moderate  ptosis.  The  simultaneous  administration  of  mineral  oil 
lubricates  the  points  of  possible  resistance  and  eases  the  jam  around  the 
corners. 

In  conjunction  with  these  measures  it  is  wise  to  limit  the  ingestion  of 
animal  foods  in  order  to  offset  the  likelihood  of  toxic  absorption.  On  the 
other  hand,  we  mui?t  be  pru- 
dent in  selecting  alternative 
nutriment,  as  carbohydrates 
have  a  tendency  to  produce 
excessive  flatulence.  We  are 
between  the  devil  and  the 
deep  sea,  and  must  steer  our 
course  with  the  gTcatest  cir- 
cumspection. Some  flatulence 
is  necessary  for  the  propul- 
sion of  the  intestinal  con- 
tents; excessive  flatulence  de- 
feats this  object,  but  the 
decomposition  of  nitrogenous 
foods  affords  the  elements  that 
poison  the  system,  whereas  the 
decomposition  of  the  carbohydrates  results  only  in  local  distress  and 
possible  edematous  obstruction. 

We  must  choose  with  an  eye  to  all  eventualities.  There  is  little  advan- 
tage in  experimenting  with  lactic  acid  and  the  Bulgarian  bacillus  for  the 
prevention  of  fermentation.  There  is  no  doubt  of  the  tendency  of  these 
agents  to  act  as  indicated,  but  it  is  a  faulty  mode  of  procedure  to  seek 
simply  to  mitigate  the  symptoms  while  permitting  the  permanence  of  the 
ascertained  and  removable  cause.  After  the  removal  of  the  cause,  both 
these  palliatives  may  be  freely  employed  to  assist  the  intestine  in  its  re- 
adjustment to  more  normal  conditions. 

The  cases  of  real  severity  threatening  life  by  the  provoking  of  organic 
diseases,  rendering  existence  a  burden  by  the  acuity  of  its  sufferings,  baf- 
fling ambition  by  persistent  incapacity,  these  incontestably  belong  to  the 
surgeon  and  can  only  be  aggravated  by  futile  attempts  at  medical  manage- 
ment. The  young  woman  with  the  muddy  complexion,  the  offensive 
breath,  the  thinning  hair,  the  loss  of  weight,  the  aching  head,  the  colicky 
bowels,  sometimes  constipated,  sometimes  malodorously  loose,  will  never 
react  to  the  Bulgarian  bacillus  or  any  system  of  dietary.     She  is  poisoned 


Fig.  11. — Band  in  which  Stump  of  Tube 
AND  OvABY  IS  Caught.  (From  Medical 
Record,  Sept.  27,  1913.) 


466  HYGIEI^'E    OF    THE    INTESTINES 

from  the  never  emptied  cloaca  within.  Until  proper  means  are  taken  to 
drain  it  effectually,  nothing  may  be  looked  for  but  an  augmentation  of 
the  evil  consequences.  The  means  described  as  proper  are  the  cutting  of 
constricting  bands  and  the  reestablishment  of  the  patency  of  the  drainage 
system. 

If  this  proves  impossible  by  any  other  course  than  the  removal  of  the 
large  intestine  and  the  discharge  of  the  ileal  effluent  directly  into  the 
pelvic  colon  (the  procedure  known  as  "short  circuiting"  the  bowel),  this 
should  be  done  without  trepidation,  since  it  sometimes  effects  a  miracle 
approaching  resurrection.  Patients  for  whom  life  holds  no  allurement, 
who  feel  that  death  would  be  surcease  of  suffering,  whose  throbbing  nerves 
are  continually  at  odds  with  their  environment,  who  consent  to  exist  only 
because  "the  Everlasting  has  fixed  His  canon  against  self -slaughter,"  are 
brought  back  to  a  world  of  sunshine  and  promise  of  efficiency  and  pur- 
pose. They  have  been  practically  snatched  from  the  grave.  They  have 
been  resurrected  from  a  living  death.  This  is  not  the  rant  of  romance ;  it 
is  the  experience  of  the  least  romantic  of  men,  the  hard-headed  English  sur- 
geon and  his  American  disciples.    Rhetoric  cannot  do  the  subject  justice. 

The  man  of  brilliant  parts  whose  career  is  threatened  with  premature 
extinction  because  of  the  increasing  effort  required  to  concentrate  his  at- 
tention on  his  work ;  who  is  becoming  dull  and  slow  and  unimaginative ; 
whose  body  is  subject  to  pains  and  paresthesias  and  overmastering  weari- 
ness; who  has  dyspepsia  and  neuralgia  and  depreciating  vision;  who  is 
listless  and  excitable  by  turns ;  whose  rest  is  broken,  urine  high  colored, 
and  bowels  constipated — had  better  resort  to  an  abdominal  surgeon  with 
strong  convictions  on  chronic  intestinal  stasis.  Hygiene  any  less  radical 
than  that  of  the  knife  will  be  of  no  avail.  Cathartics  of  every  description, 
clabbered  milk,  Bulgarian  bacillus,  bran  bread,  dieting,  exercise,  mas- 
sage, will  make  no  appreciable  impression  upon  the  progress  of  events. 
It  is  likely  that  if  he  has  not  developed  cancer,  or  tuberculosis,  or  chronic 
nephritis,  operation — ^the  highest  form  of  hygiene  under  the  circumstances, 
since  it  does  at  once  and  completely  what  other  methods  slowly  and  halt- 
ingly attempt — operation  will  clear  his  system  of  the  intoxication  due  to 
defective  drainage.  When  you  take  the  load  off  a  spring  it  resumes  its 
elasticity  and  power.  When  you  rid  the  blood  of  its  taint,  it  races  to  re- 
trieve the  mischief  of  which  it  was  the  carrier. 

Some  diseases  of  the  skin  create  a  therapeutic  dilemma.  We  are  per- 
fectly aware  of  their  putrefactive  origin.  We  locate  the  putrefaction  with 
admirable  precision.  Then  we  essay  every  mode  of  elimination  and  dis- 
infection with  which  we  are  acquainted.     We  find  out  what  the  patient 


CHRONIC    INTESTINAL    STASIS  467 

likes  to  eat  and  stop  it.  We  diet  along  the  best  approved  scientific  lines, 
and  the  disease  persists  in  apparent  indifference  to  our  ministrations. 
What  are  we  to  do^  We  are  progressive  practitioners  and  anxious  to 
give  the  patient  the  benefit  of  the  most  advanced  methods.  Shall  we  open 
the  abdomen  for  acne  ?  for  eczema  ?  for  pruritus  ?  What  a  tremendous  dis- 
proportion between  a  trivial  affection  and  a  dangerous  remedy !  At  first 
glance  this  stricture  would  seem  entirely  justified,  but  go  a  bit  deeper  and 
ask  if  acne  is  always  a  trivial  affection?  Are  there  no  circumstances 
under  which  it  rises  to  the  dignity  of  a  serious  disease  ?  Perhaps  it  never 
threatens  life,  but  it  does  threaten  the  things  that  make  life  valuable;  it 
threatens  ambition,  happiness  and  success.  On  the  face  of  a  sensitive 
woman,  it  is  an  almost  iinbearable  disfigurement.  It  embarrasses,  shames 
and  tortures  her;  it  sends  her  shrinking  from  assemblages  where  she  might 
other\yise  shine;  it  debars  her  often  from  profitable  employment;  it  de- 
prives her  of  love  and  marital  happiness.  It  is  a  conspicuously  nasty  and 
repellent  affliction.  i 

We  know  the  role  played  by  constipation  in  its  evolution.  The  acne 
bacillus  enters  little  into  our  therapeutic  calculations.  We  actually  ignore 
it  in  striving  to  overcome  the  obstinacy  of  the  intestine.  We  realize  that 
no  vaccine  can  wipe  out  the  lesions  if  the  body  is  not  sluiced  clear  of  its 
offal.  If  we  can  achieve  satisfactory  elimination  at  the  anus  we  are  far 
forward  on  the  road  to  a  favorable  result.  The  bacillus,  genuine,  legiti- 
mate and  trustworthy,  is  nevertheless  incapable  of  fruitful  insemination 
without  the  existence  of  a  responsive  soil.  If  the  skin  is  defended  by  an 
imcontaminated  circulation,  the  bacilli  may  rage  about  in  ceaseless  as- 
saults, but  they  will  never  find  a  substantial  foothold.  Hence,  in  acne, 
hygiene  is  of  more  practical  importance  than  vaccine. 

DIET  IN  ACNE.— A  properly  adjusted  diet,  properly  activated  bowels, 
properly  graduated  exercise,  ought  to  be  sufiicient  for  the  successful  man- 
agement of  the  usual  run  of  cases.  If  the  bowels  are  obdurate  and  will 
not  respond  to  vigorous  urging,  it  behooves  us  to  consider  the  likelihood 
of  a  mechanical  obstacle  and  the  existence  of  intestinal  stasis.  This  con- 
firmed, what  to  do  ?  If  the  disadvantages  of  the  eruption  are  great  enough 
to  constitute  a  serious  menace  to  happiness  or  success,  then  the  sugges- 
tion of  operation  does  not  violate  our  sense  of  proportion.  It  resolves 
itself  into  a  consideration  of  relative  values.  Is  a  clear  complexion  worth 
to  the  patient  the  risks  of  laparotomy?  Vanity  need  not  be  a  factor  in 
the  decision.  To  pander  to  such  a  vice  at  such  a  price  would  be  inde- 
fensible. But  self-respect  is  another  quality  entirely  and  may  be  bound 
up  with  problems  of  a  grave  social  or  economic  nature.     If  the  acne  is 


468  HYGIENE    OF    THE    INTESTINES 

accompanied  by  other  sjonptoins  of  stasis,  it  simply  adds  weight  to  the 
argument  in  favor  of  surgical  intervention. 

TREATMENT  IN  ITCHING  DERMATOSES,— The  itching  dermatoses  fre- 
quently get  beyond  the  pale  of  annoyance  and  into  that  of  intolerable  suf- 
fering and  loss  of  health.  Insomnia,  anorexia,  constant  irritation  and  em- 
barrassment furnish  material  for  eventual  nervous  breakdown.  If  on  ex- 
posed situations  the  eruption  brings  upon  the  sufferer  the  additional  tor- 
ment of  popular  suspicion  and  avoidance,  such  embarrassment  is  empha- 
sized to  the  limit  of  endurance.  How  far  may  distress  of  this  kiiid  be 
borne  before  invoking  the  aid  of  radical  hygiene,  the  hygiene  that  cleans 
out  with  one  move  the  objectionable  conditions  that  might  resist  inter- 
minably the  more  conservative  measures?  The  answer  lies  in  the  com- 
parison of  the  suffering  with  the  magnitude  of  the  remedy.  Everything 
is  relative.  "Laparotomy  for  eczema"  might  sound  like  the  irresponsible 
proposal  of  an  unbalanced  mind,  but  "laparotomy  for  intolerable  anguish" 
sounds  perfectly  coherent  and  rational.  Yet  the  two  may  on  occasion  be 
interchangeable  expressions. 

We  have  developed  the  question  of  intestinal  hygiene  from  the  broad 
standpoint  of  securing  results  in  specified  conditions  by  the  most  effectual 
means,  rather  than  from  the  narrower  standpoint  of  dieting  and  coaxing 
and  coddling  a  recalcitrant  organ.  We  have  intimated  that  the  use  of  the 
knife  is  the  most  hygienic  procedure  possible  under  certain  circumstances. 
Its  work  is  rapid,  complete  and  permanent.  It  drains  or  cuts  out  the 
offending  cesspool.  It  restores  the  relations  of  the  various  sections,  or 
removes  what  cannot  be  improved. 

If  the  large  intestine  is  so  out  of  plumb  that  it  cannot  be  retained  in 
the  drainage  scheme,  it  may  be  fearlessly  set  aside  and  the  ileum  inserted 
into  the  pelvic  colon.  Less  sweeping  measures  than  this  are  ordinarily 
indicated.  The  release  of  encompassed  gut  is  the  object  of  the  operation. 
The  least  mutilation  consistent  with  its  proper  performance  is  the  rule 
to  be  adhered  to.  If  the  kinks  can  be  straightened  out  by  the  cutting  of 
constricting  bands  and  the  tide  set  fairly  in  the  direction  of  the  anus,  the 
pathological  situation  has  been  relieved  and  all  the  symptoms  dependent 
thereon  should  speedily  disappear. 

Repetition  serves  to  inculcate  more  forcibly  the  truth  of  any  proposi- 
tion. We  shall  therefore  venture  to  reiterate  the  sometimes  forgotten  fact 
that  orthopedic  siirgery  is  bloodless  on  occasion,  that  corrective  achieve- 
ments are  possible  without  the  intervention  of  the  knife;  thus  a  case  of 
moderate  ptosis  may  be  materially  relieved  by  the  abdominal  bandage 
below  the  umbilicus  and  the  administration  of  mineral  oil. 


CHRONIC    INTESTINAL    STASIS  469 

The  limitation  of  nitrogenized  food  will  add  to  the  security  of  the 
patient.  The  omission,  of  foods  with  bulky  residue  tending  to  aggravate 
the  ptosis  and  also  to  constrict  barely  adequate  openings  will  contribute 
largely  to  the  same  end. 

Hygiene  of  the  Intestinal  Canal — The  great  demand  to-day  is  not  for 
the  cure,  but  the  prevention  of  disease.  Scientific  observation  is  directed 
to  the  discovery  of  the  causes  of  the  graver  maladies  with  the  view  of 
eliminating  them,  so  with  regard  to  intestinal  stasis,  the  greater  art  would 
be  in  preventing  its  occurrence.  To  do  this  we  must  hark  back  to  infancy 
and  regulate  the  intestinal  hygiene  along  enlightened  lines.  The  baby 
must  be  fed  and  not  overfed.  That  is  imperative.  Most  infants  are  glut- 
tons who  will  gorge  themselves  far  beyond  their  ability  to  assimilate. 
This  excess  must  be  controlled ;  after  nursing  they  should  not  be  dandled 
or  even  set  upright.  They  must  be  laid  down  and  let  alone.  Constipa- 
tion should  be  combated  without  cessation.  Flatulence  and  colic  distend 
the  delicate  viscera  and  stretch  the  feeble  attachments.  Improper  ali- 
ment such  as  "a  little  bit  of  everything  off  the  table,"  and  most  of  the 
baby  foods  on  the  market  contribute  to  this  occurrence.  A  diet  on  which 
the  baby  thrives  with  no  colicky  interludes  and  with  perfect  evacuations 
will  minimize  the  chances  of  faulty  structural  change. 

As  childhood  advances,  sports  beyond  the  strength  of  boys,  and  tight- 
fitting  apparel  for  girls  should  be  interdicted;  especially  should  boys  be 
warned  against  the  detrimental  effect  of  blows  in  the  abdomen.  The  fool- 
ish desire  for  a  pretty  figure  denied  by  nature  and  induced  by  art,  has 
been  the  cause  of  many  an  operation  for  stasis.  This  will  arouse  unani- 
mous disapproval  among  the  devotees  of  fashion,  but  it  is  nevertheless  the 
surest  fact  in  coniiection  with  the  etiology.  Patients  who  are  convalescing 
from  prostrating  illnesses  are  prone  to  the  development  of  enteroptosis 
because  of  the  weakening  of  the  visceral  supports.  Obesity  interlarding 
the  viscera  with  inert  masses  of  functionless  fat,  and  coincidentally  reduc- 
ing the  muscular  tone  of  the  abdominal  and  intestinal  walls,  creates  ideal 
conditions  for  the  production,  of  stasis.  Gluttony  overtaxes  the  propulsive 
powers  of  the  overloaded  intestine,  and  ptosis  is  a  natural  consequence. 

Hygiene  of  the  intestinal  canal  then  practically  resolves  itself  into  the 
prevention  of  chronic  intestinal  stasis  and  the  removal  of  this  abnormality 
after  its  unfortunate  development.  Transient  disturbances  may  demand 
attention,  such  as  the  acute  diarrhea  from  over-ripe  fruit  or  the  jamming 
of  the  rectum  with  undigested  casein.  Tubercular  diarrhea  may  be  cited 
as  an  episode  in  the  course  of  a  fatal  disease  and  requires  medicinal  treat- 
ment.   The  diarrhea  of  typhoid  fever  is  an  incident  calling  for  alteration 

130 


470  HYGIENE    OF    THE    INTESTINES 

in  the  feeding.  These  are  not  included  in  the  broad  consideration  of  hy- 
giene of  the  intestinal  canal. 

The  latter  has  to  do  with  conditions  that  will  not  pass  away  with  time 
or  with  the  cessation  of  an  acute  process.  They  are  deep-rooted  in  the 
mechanism  of  fecal  drainage.  They  are  structural  defects  whose  evils 
may  be  palliated  in  favorable  cases  by  careful  scrutiny  of  the  nutritive 
intake  and  vigorous  enforcement  of  a  corresponding  output. 

Palliation  exhausts  the  possibilities  of  hygiene  in  the  usual  sense. 
But  in  the  wider  sense  of  the  utilization  of  every  means  for  the  restoration 
of  the  normal  function  of  the  part,  the  surgeon  with  his  knife  is  as  much 
a  hygienist  as  the  physician  with  his  computed  calories  and  mineral  oil. 
The  plumber  who  takes  out  a  length  of  occluded  pipe  is  as  much  an  agent 
of  sanitary  science  as  the  housewife  who  takes  pains  to  prevent  its  occlu- 
sion. The  surgeon  who  repairs  our  human  plumbing  is  the  most  com- 
manding factor  in  the  hygiene  of  the  intestinal  canal. 

BIBLIOGRAPHY 

Bainbeidge,  William  Seaman.  The  Significance  of  Intra-abdominal 
Bands,  Folds  and  Veils,  Boston  M.  &  S.  J.,  Feb.  19,  1914. 

.     Chronic  Intestinal  Stasis,  Am.  J.  Obst.,  1916,  vol.  Ixxiii, 

No.  2. 

.  Oration  on  Surgery  before  the  Annual  Meeting  of  the  Med- 
ical Association  of  Alabama,  April  20  to  24,  1915. 

.     Chronic  Intestinal  Stasis,  Fluoroscopic  and  X-Ray  Diagnosis 

in  the  Light  of  the  Operative  Findings,  J.  Mich.  S.  M.  Soc., 
March,  1915. 

.     Some  Practical  Points  on  Human    Plumbing,  Internat.  J. 

Surg.,  November,  1916. 

JoKDAN,  Alfred  C.  Radiography  in  Intestinal  Stasis,  Proc,  Roy.  Soc. 
Med.,  vol.  V,  1911. 

Lane,  Sir  Arbuthnot.     Proc.  Roy.  Soc.  Med,,  vol.  iv,  March,  1913. 


CHAPTER   XV 

PHYSIOLOGICAL   REQUIREMENTS    OF   INFANT   FEEDING 

IN  HEALTH 

William  C.  Hollopeter,  A.M.,  M.D.,  LL.D. 


Breast  Feeding:  Relative  Frequency  of  Breast  Feeding;  Microorganisms 
in  Breast  Milk;  Colostrum;  Quantity  of  Breast  Milk;  Constituents 
of  Breast  Milk;  Galactagogues;  Necessity  for  Intelligent  Mothers; 
Nursing;  Consideration  of  Breast  Milk;  Mixed  Feeding;  Contra-Indi- 
cations  to  Breast  Feeding. 

Artificial  Feeding  of  Infants;  Certified  Milk;  Composition  of  Cow's  Milk; 
Condensed  Milk;  Buttermilk;  Peptonized  Milk;  Sterilized  Milk;  Pas- 
teurized Milk;  Proprietary  or  Patent  Foods;  Home  Modification  or 
Adaptation  of  Milk;  Clinical  Application  of  Artificial  Feeding;  Home 
Modification  of  Cow's  Milk. 

Summary  of  Rules  to  be  Observed  in  Artificial  Feeding. 


BREAST    FEEDING 

Breast  feeding  has  been  regarded  by  many  writers  on  pediatrics  as 
a  lost  art.  Fortunate  indeed  is  the  young  mother  who  can  supply  her 
child  with  a  full  amount  of  well-balanced  nutritious  food.  The  high  phys- 
ical and  mental  tension  forced  upon  most  of  us  to-day  calls  for  an  evenly 
poised  nervous  mechanism,  and  as  a  result,  we  find  many  who  fall  below 
this  standard.  Among  the  well-to-do  it  was,  until  a  few  years  ago,  the 
exception  that  the  young  mother  could  acceptably  nurse  her  child  wholly 
for  six  months. 

Ten  to  fifteen  years  ago,  fully  75  per  cent  of  the  young  mothers  were 
unable  to  nurse  their  ofi'spring,  but  now,  thanks  to  a  growing  spirit  of 
maternal  pride,  associated  with  sounder  physiological  knowledge  and  the 
increasing  tendency  towards  outdoor  education,  this  difference  is  passing 
away  and  to-day  we  see  more  mothers  proud  and  willing  to  nurse  their 
offspring.     The  young  mother  of  to-day  is  better  equipped  physically  and 

471 


472  KEQUIKEMENTS    OF    INFANT    FEEDING 

mentally  to  nurse  her  offspring  than  was  her  sister  of  twenty  years  ago. 
This  is  due  to  the  fact  that  she  has  had  a  better  all-around  education,  is 
a  better  type  of  animal — more  vigorous  by  reason  of  outdoor  life — than 
the  woman  of  two  decades  ago.  Still,  we  have  too  many  sentimental  young 
mothers  who  will  not,  or  can  not,  nurse  their  offspring,  due  probably,  in 
part,  to  faulty  parental  training.  On  the  other  hand,  it  is  all  wrong  to 
accuse  the  young  mother  of  inability  to  nurse  her  child  without  careful 
study  of  existing  conditions.  A  child  may  be  of  low  vitality  with  sensi- 
tive digestive  powers  and  will  feel  the  slightest  abnormality  in  the 
mother's  milk.  And  all  mothers'  milk  at  first  may  lack  the  proper  pro- 
portion of  food  elements  due  to  fear  of  pain  and  general  discomfort  of 
the  parturient  act.  In  many  cases,  this  enfeebled  digestive  power  in  the 
child,  associated  with  slight  abnormality  in  the  maternal  supply,  is  the 
cause  of  the  nursing  being  discontinued. 

Many  mothers  do  not  secrete  the  requisite  supply  of  milk  until  two 
or  three  weeks  after  confinement.  This  variation  of  supply  should  be 
recognized  both  by  the  physician  and  mother  and  carefully  studied  before 
any  radical  changes  are  suggested.  Frequently  we  have  found  a  high 
fat,  sugar  or  protein  content  which  corrected  itself  within  a  few  weeks. 
This  condition  ordinarily  warrants  a  discontinuance  of  nursing  of  a  feeble 
infant,  while  in  a  vigorous  infant  it  would  be  a  matter  of  small  moment. 

While  we  have  just  cause  to  rejoice  in  the  increasing  number  of  nurs- 
ing mothers  by  reason  of  better  physique  and  more  general  knowledge, 
due  in  part  to  the  increasing  number  of  young  women  who  play  golf,  ride 
horseback,  or  play  tennis,  and  the  progressive  use  of  the  automobile,  we 
still  have  too  many  of  the  nervous  type — the  neurotic  mother — in  spite  of 
outdoor  exercise.  The  neurotic  mother  is  the  stumbling  block  to  the  pedia- 
trician's success— she  makes  a  poor  nurse,  her  milk  constantly  varies  in 
composition,  and  she  cannot  be  depended  upon  to  produce  regularly.  The 
neurotic  mother  has  been  the  means,  however,  of  the  great  advance  in 
careful  feeding,  even  if  she  is  responsible  for  so  many  delicate  children. 
At  the  present  day,  the  decline  of  neurasthenic  mothers  is  strongly  in 
evidence;  they  are  less  numerous,  not  popular,  and  will  further  decrease 
in  the  next  ten  years,  because  the  great  outdoors  has  lately  become  the 
fashion. 

Relative  Frequency  of  Breast  Feeding. — The  relative  frequency  of  breast 
feeding  varies  with  different  countries.  In  Japan,  all  mothers  nurse  their 
offspring.  Among  the  Eskimos,  artificial  feeding  is  unknown.  At  the 
Woman's  Dispensary  in  Munich,  an  investigation  revealed  the  fact  that 
only  3.6    per  cent  of  women  examined  nursed   their  offspring  longer 


BREAST    FEEDING  473 

than  three  months.  Davis(l),  studying  this  (juestion  in  the  city  of  Boston, 
in  11)11,  found  that  08  per  cent  of  babies  between  the  ages  of  two  weeks 
and  one  year  were  breast-fed,  while  in  the  city  of  Kew  York  the  estimates 
of  the  Board  of  Health (2)  record  that  85  per  cent  of  the  infants  in  New 
York  City  are  breast-fed.  Koplik(3)  investigated  1,007  infants  in  pri- 
vate practice  in  the  city  of  New  York  and  found  only  10  per  cent  exclu- 
sively breast-fed,  while  30  per  cent  were  exclusively  bottle-fed,  60  per  cent 
breast-  and  bottle-fed,  and  40  per  cent  were  weaned  before  the  fourth 
month. 

Dr.  Eric  Pritchard(4)  of  London,  through  "mothercraft  societies" 
first  instituted  at  the  Marylebone  Street  Hospital,  has  started  an  edu- 
cational propaganda  of  enlightenment  on  the  subject  of  infant  feeding 
that  is  spreading  throughout  the  British  Isles  and  beyond  like  a  fierce  and 
living  contagion.  Since  the  inception  of  these  infant  consultations,  or 
schools  for  mothers,  the  death  rate  has  fallen  from  155  per  1,000  births 
to  95  per  1,000,  and  in  the  city  of  London  to  91.  In  Berlin(5),  where 
infant  feeding  is  under  government  control,  reports  show  that  from  1900 
to  1904  only  9  per  cent  of  infantile  deaths  occurred  in  breast-fed  children. 

The  Health  Department  of  the  city  of  New  York  concludes  from  the 
statistics  gathered  by  the  Commissioner  of  Health  that  fully  85  per  cent 
of  the  infant  mortality  occurred  in  infants  artificially  fed (6).  In  the 
city  of  Boston,  in  1911,  the  mortality  of  infants  over  two  weeks  old 
reached  74  per  cent  in  the  artificially  fed,  and  Davis (7)  concludes  that 
the  bottle-fed  is  six  times  as  likely  to  die  as  the  breast-fed  infant.  Luling 
of  Paris(8),  in  a  study  of  13,952  children  born  in  Baudelocque's  Clinic, 
reports  a  mortality  of  14  per  cent  in  breast-fed  babies,  and  31  per  cent  in 
babies  who  were  bottle-fed  by  their  own  mothers,  and  50  per  cent  in  babies 
who  were  bottle-fed  by  strangers. 

In  the  city  of  Liverpool,  Armstrong(9)  reports  in  a  study  of  1,000 
infants  in  1903,  that  of  the  breast-fed  babies  8.4  per  cent  died  in  the  first 
year  against  a  mortality  of  22.8  per  cent  among  the  artificially  fed.  The 
Health  Department  of  the  city  of  New  York  investigated  the  cause  of 
diarrheal  disorders  occurring  in  1908  and  found  that  only  9.0  per  cent 
had  been  previously  breast-fed. 

"As  a  twig  is  bent,  so  the  tree  is  inclined,"  applies  with  especial  em- 
phasis to  the  nutrition  of  the  young  child.  Success  in  infant  feeding 
demands  the  careful  observance  of  little  details ;  it  is  not  possible  to  feed 
carefully  for  one  or  more  weeks  and  then  grow  careless  for  even  a  few 
days,  for  by  so  doing,  we  will  either  fail  to  gain  that  daily  advance  in 
development  which  is  so  essential  in  infancy,  or  possibly  even  precipitate 


474  EEQUIEEMENTS    OF    IXFANT    FEEDING      . 

an  acute  illness.  The  young  mother  left  to  her  own  devices  will  make 
changes  in  diet  not  warranted  by  the  child's  condition,  but  largely  at  the 
suggestion  of  poorly  informed  friends. 

This  fact  is  well  illustrated  by  the  comparison  of  private  cases  with 
dispensary  cases ;  fully  forty  per  cent  of  the  out-patient  dispensary  cases 
are  below  the  average  in  weight  and  development,  in  contra-distinction 
to  the  private  cases,  less  than  ten  per  cent  of  whom  fall  below  this  aver- 
age. These  dispensary  children  are  the  offspring  of  day  laborers,  me- 
chanics, waiters,  and  other  small  wage  earners;  they  are  fed  correctly 
at  times,  and  again  incorrectly,  not  because  of  poverty,  but  because  their 
mothers  do  not  know. the  very  important  principle  of  regularity;  neither 
do  they  understand  the  value  of  food  nor  the  necessity  for  giving  it  at 
regular  specified  intervals.  The  children  are  not  hungry;  they  are  fed 
to  satisfy  the  appetite,  and  not  to  nourish  the  body.  To  feed  their  chil- 
dren to  encourage  a  definite  purpose — the  proper  physical  development — 
has  never  entered  their  minds.  It  is  for  this  reason  that  breast  feeding 
must  be  vigorously  encouraged  and  rigidly  supervised ;  otherwise  we  will 
soon  be  a  race  of  physical  defectives. 

Microorganisms  in  Breast  Milk.  —  The  breast-fed  infant  receives  its 
food  direct  from  nature's  fountain,  and,  because  it  comes  direct,  it  is  re- 
garded as  sterile.  The  truth  is,  however,  that  organisms  from  the  breast 
gland  itself  get  into  the  milk  (10).  Careful  investigation  shows  that  the 
milk  of  healthy  women,  whose  breasts  are  free  from  pathologic  condi- 
tions, contains  microorganisms.  In  the  majority  of  instances,  the  staphyl- 
ococcus aureus  is  found.  It  is  believed  that  the  bacteria  enter  the  breast 
from  the  outside.  Milk  carefully  drawn  is  usually  found  sterile.  This 
question  of  sterile  human  milk  remains  to  be  settled,  but  for  all  practical 
purposes  we,  as  pediatricians,  feel  that  breast  milk  is  sterile.  Syphilis  has 
been  induced  in  rabbits  by  inoculating  them  with  milk  from  a  syphilitic 
woman,  although  the  woman's  milk  was  sterile  and  on  examination  no 
spirochaetae  pallidas  were  found  (11). 

Typhoid  bacilli  were  found  by  Lawrence  in  the  milk  of  a  woman  suf- 
fering from  typhoid  fever (12).  Bacteria,  unless  present  in  unusual  num- 
bers, ordinarily  produce  no  ill  effects  in  breast-fed  children,  because  the 
germs  found  in  human  milk  have  no  pathological  significance  for  a  healthy 
infant.  It  has  been  shown,  however,  that  this  is  not  the  fact  in  infants 
with  an  injured  digestion.  Moro  has  recently  ascribed  to  the  staphylo- 
cocci in  human  milk  an  etiologic  factor  in  the  dyspeptic  conditions  of 
breast-fed  infants (13). 

The  taste  and  appearance  of  human  milk  is  practically  the  same  as 


BREAST    FEEDIi^G 


475 


that  of  cow's  milk.  Human  milk  has  no  odor,  and  tastes  sweeter  than 
cow's  milk;  it  may  look  paler  or  bluish.  When  cool,  small  white  flakes 
cling  to  the  side  of  the  vessel ;  these  disappear  when  the  milk  is  warmed. 

The  microscopic  appearance  of  human  milk  reveals  it  as  a  permanent 
emulsion  containing  many  fat  droplets.  It  also  contains  a  few  leukocytes 
and  epithelial  cells. 

Colostrum — The  milk  excreted  during  the  first  few  days  postpartum 
and  know^n  as  colostrum,  differs  materially  from  that  after  lactation  is 
fully  established.  Colostrum  is  as  sweet  as  milk;  of  a  deep  lemon  yellow 
tint — due  to  a  coloring  matter  contained  in  the  fat  drops.  The  percentage 
of  cholesterin  and  lecithin  is  greater  than  in  milk.  The  fat  of  colostrum 
contains  less  of  the  volatile  fatty  acids  than  does  normal  milk.  The  spe- 
cific gravity  of  colostrum  ranges  from  1.028  to  1.072,  the  average  being 
about  1.040. 

Konig  gives  the  following  analysis  as  an  average  composition  of  colos- 
trum: water,  86,4;  nitrogenous  substances,  3.07;  fat,  3.34;  lactose,  5.27; 
salts,  0.40.  We  give  below  a  table  from  Czerny  and  Keller,^  graphically 
showing  the  composition  of  colostrum  according  to  various  investigators : 

COMPOSITION  OF  COLOSTRUM 


Day 

Fat 

Lactose 

Protein 

Nitrogen 

Ash 

SoUds 

Author 

postpartum 

% 

% 

% 

% 

% 

% 

Pfeiflfer 

1 

2.59 

2.76 

9.75 

0.408 

Pfeiffer 

2 

2.17 

3.50 

7.45 

0.340 

Adriance..  . . 

2 

3.77 

5.39 

3.31 

0.27 

12.48 

Camerer  and 

26-51 

4.08 

4.09 

0.928 

0.48 

16.04 

Saldner. . . 

56-61 

3.92 

5.48 

0.508 

0.41 

14.12 

Camerer  and 

26-48 

1.67 

5.20 

.336 

.36 

10.32 

Saldner. . . 

148-69 

2.02 

5.08 

.226 

.40 

10.12 

Pfeiffer  after  repeated  examinations  concludes  that  the  nitrogenous 
substances  in  human  milk  ordinarily  range  as  follows:  first  day,  8.6  per 
cent;  third  day  to  tenth,  3.4  per  cent;  at  end  of  second  week,  2.28  per 
cent;  in  the  second  month,  1.84  per  cent;  in  the  seventh  month,  1.52  per 
cent.  The  percentage  of  sugar  increases  in  human  milk  while  the  protein 
decreases.  The  mineral  content  of  colostrum  and  of  breast  milk  after 
lactation  is  established  is  essentially  different. 


1  Quoted  by  Morse  and  Talbot,  "Diseases  of  Nutrition  and  Infant  Feeding,"  p.  94, 
pub.  by  the  Macmillan  Company. 


476 


KEQUIKEMENTS    OF    INFANT    FEEDING 


Specific  gravity  is  usually  given  as  1.030-1.032.  It  may  fall  as  low 
as  1.020  or  go  as  high  as  1.036(14). 

The'  reaction  of  human  milk  is  amphoteric.  It  is  acid  to-  phenolphtha- 
lein,  and  alkaline  to  litmus.  The  reason  for  the  double  reaction  is  the  fact 
that  human  milk  contains  both  mono-  and  diphosphates.  The  former  are 
weakly  acid,  while  the  latter  react  as  a  base. 

Quantity  of  Breast  Milk. — The  amount  of  human  milk  secreted  by  a 
healthy  mother  greatly  depends  on  the  demands  of  the  child.  The  size, 
weight  and  vigor  of  the  infant  will  indicate  the  exact  amount  of  milk 
extracted  from  the  breast  in  each  twenty-four  hours.  It  is  natural,  there- 
fore, to  conclude  that  a  weak,  immature  child  would  not  demand  the  same 
amount  as  a  lusty,  vigorous  infant.  What  would  be  a  normal  quantity 
for  one  child  would  not  be  normal  for  another ;  therefore  averages  are  not 
of  any  special  value. 

The  exact  amount  of  milk  extracted  at  each  nursing  is  obtained  by 
weighing  either  mother  or  child  before  and  after  each  nursing.  Cra- 
mer (15)  shows  that  multiparse  secrete  a  third  more  than  primiparae.^ 

QUANTITY  IN  SECRETION  OF  MILK  BY  PRIMIPARA  AND  MULTIPARA 


Day 

TwENTY-FOUR-HoUR  AMOUNT 

OF  Milk  in 

Grams 

Postpartum 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

Nine  Babies  Primipara — 
Wt.     at    Birth    3.290 
grams 

4 
6 

78 
129 

183 
238 

199 
324 

236 
344 

299 
324 

303 
361 

274 
365 

362 
384 

384 

Seven   Babies  Multipara 
— Wt.    at  Birth  3.348 
grams 

415 

The  average  daily  quantity  of  milk  secreted  by  healthy  young  mothers 
under  normal  conditions  has  been  approximately  determined  as  follows: 


Period  of  Lactation 

Approximate  Quantity  in  Grams 

Ounces 

Grams 

At  the  end  of  1st  week 

10  to  16 

13  to  18 

14  to  24 
16  to  26 
20  to  34 
24  to  38 
30  to  40 

300  to    500 

At  the  end  of  2nd  week 

400  to    550 

During  3rd  week 

430  to    720 

During  4th  week 

500  to    800 

From  5th  to  13th  week 

600  to  1  030 

From  4th  to  6th  month 

720  to  1,150 
900  to  1,220 

From  6th  to  9th  month 

1  Quoted  by  Morse  and  Talbot,  "Diseases  of  Nutrition  and  Infant  Feeding." 


BREAST    FEEDING 


477 


Czerny  and  Keller (16)  give  more  details  as  to  the  amount  of  breast 
milk  secreted  by  the  average  mother.^  They  show  that  the  activity  of  tlie 
maternal  breast  may  be  greatly  increased  if  the  mother  nurses  one  or 
more  babies,  as  is  found  in  a  wet-nurse.  They  refer  to  a  wet-nurse  whose 
amount  of  milk  secreted  in  ten  days  increased  from  720  grams  when  she 
nursed  two  'infants,  to  1,750  grams  when  she  nursed  five  infants. 

AVERAGE  DAILY  AMOUNT  OF  MILK  DRAWN  BY  A  BABY 

(Czerny  and  Keller) 


Age 

in 

Weeks 

Average  weight 

of  breast-fed 

babies  given  in 

grams 

The  calculated 
days — amt.  of 
milk  in  grams 

Age 

in 

Weeks 

Average  weight 

of   breast-fed 

babies  given  in 

grams 

The  calculated 
days — amt.  of 
milk  in  grams 

1 

3.410 

291 

14 

5.745 

870 

2 

3.550 

549 

15 

5.950 

878 

3 

3.690 

590 

16 

6.150 

893 

4 

3.980 

652 

17 

6.350 

902 

5 

4.115 

687 

18 

6.405 

911 

6 

4.260 

736 

19 

6.570 

928 

7 

4.495 

785 

20 

6.740 

947 

8 

4.685 

804 

21 

6.885 

956 

9 

4.915 

815 

22 

7.000 

958 

10 

5.055 

800 

23 

7.150 

970 

11 

5.285 

808 

24 

7.285 

980 

12 

5.455 

828 

25 

7.405 

990 

13 

5.615 

852 

26 

7.500 

1,000 

Constituents  of  Breast  Milk — Coagulation  has  been  more  carefully 
studied  by  means  of  the  ultramicroscope.  The  essential  differences  in  the 
coagulation  of  human  and  cow's  milk  are  as  follows(17) :  The  casein 
of  human  milk  is  precipitated  with  gTeater  difficidty  with  acids  or  salts 
and  it  does  not  coagulate  uniforndy  after  the  addition  of  rennet,  while 
the  clot  that  forms  does  not  appear  in  such  large  coarse  masses  as  the 
casein  from  cow's  milk,  but  is  more  loose,  feathery  and  flocculent. 

ALBUMINOUS  BODIES. — The  albuminous  bodies  in  human  milk  are 
classed  under  two  groups:  (a)  casein,  which  is  insoluble  in  water,  and  (&) 
lactalbumen  and  globulin,  which  are  also  insoluble  in  water.  The*  separa- 
tion of  these  bodies  in  human  jnilk  is  more  difficult  than  in  cow's  milk, 
because  of  the  difficulty  in  precipitating  the  casein.  There  is  on  this  ac- 
count much  opportunity  for  further  investigations  to  add  to  our  knowl- 
edge of  the  proteins  of  human  milk.  The  figures  which  are  most  generally 
accepted  are  those  of  Schlossman(18),  who  found  that  about  41  per  cent 
of  the  total  nitrocen  is  in  the  form  of  casein. 


1  Quoted  by  Morse  and  TaU)ot,  "Diseases  of  Nutrition  and  Infant  Feeding. 


478  EEQUIREMEXTS    OF    INFANT    FEEDING 

Caseix. — Casein  is  difficult  to  precipitate  from  human  milk.  It  re- 
quires a  large  amount  of  human  milk  to  conduct  an  analysis,  and  this 
has  retarded  our  knowledge  of  the  subject.  We  know  more  about' cow's 
casein  than  human  casein.  As  casein  is  insoluble  in  water,  we  must  add 
an  alkali,  such  as  sodium  citrate.  On  adding  acid  to  this  alkaline  solu- 
tion, the  casein  will  again  be  precipitated. 

FAT. — The  fat  in  human  milk  is  in  a  very  fine  emulsion.  When  the 
number  of  drops  are  counted  in  a  counting  chamber,  more  will  always 
be  found  in  human  milk  than  in  cow's  milk  (19).  The  figures  as  to  the 
percentage  of  fat  and  the  total  amount  of  fat  in  human  milk  vary  accord- 
ing to  the  various  investigators  and  the  methods  pursued.  Engel's(20) 
monograph  on  human  milk  gives  the  most  complete  summary  of  the 
knowledge  on  this  subject,  and  is  quoted  freely  in  this  article.  He  says 
the  percentage  of  fat  is  smallest  at  the  beginning  of  nursing  and  largest 
at  the  end  of  nursing,  the  steepness  of  the  curve  depending  on  the  total 
amount  of  milk  taken  at  a  nursing.  When  a  small  amount  is  taken,  there 
is  a  sharp  rise  in  the  percentage  of  fat,  and  when  a  large  amount  of  milk 
is  taken,  there  is  a  more  gradual  rise.  The  percentage  of  fat  in  the  first 
milk  drawn  varies  between  1  and  3  per  cent,  and  that  in  the  last  milk 
taken  between  6  and  10  per  cent.  These  figures  may  occasionally  be  even 
higher.  In  pathological  conditions  the  extremes  of  the  percentage  of  fat 
are  0.1  per  cent(21)  and  13.7  per  cent(22). 

The  average  fat  content  of  the  milk  of  ten  wet-nurses  (German)  ex- 
amined by  Engel  was  4.5  per  cent,  and  of  119  women  (Russian)  exam- 
ined by  8kvorlzov(23),  3  per  cent.  The  amount  of  fat  in  the  milk  of  the 
same  women  may  vary  from  25  to  100  per  cent  in  the  same  day  at  differ- 
ent nursings.  When  the  intervals  of  emptying  the  breasts  are  long,  there 
is  more  milk  and  less  fat.  Wlien  all  the  milk  of  a  woman  is  collected 
each  day,  the  average  daily  percentage  is  constant.  This  is  true  even 
if  the  total  amount  of  milk  is  considerably  increased. 

LACTOSE. — Milk  sugar  is  found  only  in  the  milk  of  mammals.  It  is 
essentially  the  same  in  the  milk  of  woman,  the  cow,  ass,  rabbit,  dog  and 
horse  (24).  There  is  evidence  which  suggests  strongly  that  lactose  is 
formed  from  the  dextrose  in  the  blood  (25).  The  quantity  of  lactose 
varies  the  least  of  all  the  elements  of  human  milk.  The  amount  of  lactose 
in  human  milk  is  almost  twice  that  in  cow's  milk,  being  on  the  average 
about  7  per  cent.  The  lowest  percentage  which  has  been  found  is 
4.22(26),  and  the  highest  10.9  per  cent(27).  A  few  instances  have  been 
recorded  in  which  the  addition  of  sugar  to  thfe  diet  of  the  mother  has 


BREAST    FEEDING  479 

increased  the  amount  of  sugar  in  the  milk.  This,  however,  is  by  no  means 
the  nUe(28). 

FERMENTS  (ENZYMES).— Many  pediatric  writers  place  much  impor- 
tance on  the  ferments  or  enzymes  of  milk,  especially  in  the  discussions  as 
to  whether  raw  or  boiled  milk  is  the  more  digestible  for  infants,  and  in 
connection  with  the  diseases  of  metabolism,  such  as  scorbutus  and  rachi- 
tis. The  study  of  the  ferments  is  open  to  error  because  of  the  presence 
of  bacteria  in  milk.  It  is  almost  impossible  to  obtain  a  truly  sterile  sam- 
ple of  milk  or  to  keep  that  milk  sterile  for  any  length  of  time.  The  use 
of  toluol  or  chloroform  to  keep  the  milk  sterile  may  modify  or  destroy  the 
enzymes,  while  sterilization  by  heat  always  destroys  them.  As  the  action 
of  bacteria  may  caiise  all  the  phenomena  produced  by  the  ferments  in 
milk,  the  presence  of  bacteria  must  always  be  excluded. 

Galactagogues — In  many  nursing  mothers  who  do  not  secrete  sufficient 
milk  to  ensure  the  gradual  physiological  growth  of  the  child,  it  becomes 
of  practical  importance  to  know  if  we  possess  means  of  any  value  to 
stimulate  the  lacteal  secretion.  Hence  a  few  words  on  the  value  of  galac- 
tagogues  may  be  instructive.  Schafer  and  MacKenzie(29)  found  that 
the  posterior  lobe  of  the  pituitary  body  of  the  ox  and  the  corpus  luteum 
of  sheep  both  act  as  galactagogues  when  injected  into  cats  and  dogs. 
Hammond  (30)  found  that  the  injection  of  pituitary  extract  into  lactating 
goats  increased  the  amount  of  milk  for  twenty-four  hours.  However,  the 
amount  secreted  during  the  next  twenty-four  hours  decreased  below  the 
normal,  so  the  average  of  the  two  days  was  the  normal  amount. 
Gavin(31)  did  not  find  that  the  pituitary  extract  affected  the  quantity  of 
milk  in  cows. 

MacKenzie  and  others (82)  believe  that  the  mammary  gland  can  be 
stimulated  by  the  administration  of  the  posterior  lobe  of  the  pituitary 
body,  the  pineal  body,  and  the  corpus  luteum.  The  action  of  the  former 
is  supposed  to  be  the  most  powerful.  Inhibitory  substances  are  said  by 
some  observers  to  be  produced  by  the  fetus,  placenta,  spleen,  pancreas, 
adrenals  and  thyroid.  Aschner  and  Grigori(33),  on  the  other  hand,  found 
that  the  pulp  of  placenta  or  its  watery  extracts  caused  a  true  secretion  of 
milk  in  virgin  animals  and  that  the  body  which  causes  this  secretion  is  de- 
stroyed by  alcohol  and  heat.  Basch(34)  reports  that  substances  present 
in  the  placenta  when  injected  into  animals  will  bring  back  the  secretion 
of  milk  after  it  has  stopped. 

Wolf  (35)  injected  milk  into  nursing  women  and  found  that  there  was 
an  increase  in  the  amount  of  milk  secreted.  Chatin  and  Rendu (36)  re- 
peated Wolf's  work  with  eight  women,  giving  thirteen  injections  of  milk 


480  KEQUIEEMENTS    OF    INFANT    FEEDING 

with  the  result  that  in  eight  instances  the  curve  of  milk  secretion  re- 
mained stationary  or  became  slightly  lowered.  In  the  five  remaining 
instances  there  was  a  slight  increase  in  the  amount  of  milk  secreted  after 
the  injections  of  milk.  This  increase  was,  however,  always  in  association 
with  other  factors,  such  as  a  change  in  the  number  of  nursings,  or  a 
greater  demand  on  the  part  of  the  infant.  They  believe  that  the  latter 
was  the  cause  of  the  increase  and  not  the  former (37). 

There  is  much  evidence  to  show  that  substances  secreted  in  the  ovary 
cause  the  growth  of  the  breast  gland  at  puberty.  Cramer (38)  believes 
that  it  has  no  influence  on  the  hyperplasia  of  pregnancy,  while  Bascli(39), 
on  the  other  hand,  attributes  the  increase  in  size  of  the  breast  glands  to  a 
secretion  in  the  ovary.  The  blood  of  a  pregnant  animal  injected  into  a 
lactating  animal  has  no  influence  on  the  secretion  of  milk  (40).  Engel 
after  considerable  investigation  concludes  that  there  are  no  artificial 
means  of  increasing  the  secretion  of  milk. 

Herbert  Spencer  has  said,  "The  first  requisite  for  success  in  life  is 
to  be  a  good  animal" ;  and  to  be  a  country  or  nation  of  good  animals  is 
the  first  essential  of  national  prosperity.  To  approach  this  essential  or 
national  prosperity  in  the  right  direction  is  the  establishing  of  training 
schools  for  teachers  and  a  department  of  dietetics  and  food  economics  in 
the  various  cities.  This  has  been  accomplished  in  many  of  our  larger 
towns  and  with  wonderful  success.  The  students  are  taught  food  values, 
food  preparation,  the  way  to  provide  the  most  nutritious  food  in  its  most 
attractive  form  for  a  given  sum  of  money. 

Necessity  for  Intelligent  Mothers — Of  the  hundreds  of  teachers  sent 
out  from  their  dietetic  departments  of  instruction  every  year  to  assume 
responsibility  over  children  in  all  parts  of  the  country,  each  and  every 
one  has  learned  something  of  dietetics  and  food  values  and  will  impart 
this  knowledge  and  point  out  the  great  importance  of  correct  feeding. 
The  teachers  will  impress  on  the  growing  child  the  value  of  good  food, 
without  which  the  very  best  type  of  adult  possible  cannot  be  realized. 
More  members  of  our  profession  should  be  interested  in  the  support  of 
dietetics  and  more  departments  of  the  same  be  firmly  established  in  every 
high  school  for  girls  throughout  our  land.  This  may  not  seem  to  apply 
especially  to  maternal  nursing,  but  I  have  not  forgotten  its  application. 
The  food  and  hygiene  of  the  growing  girl  have  the  closest  bearing  upon 
her  future  life,  and  when  she  is  called  upon  to  perform  her  most  impor- 
tant duty,  motherhood,  she  certainly  has  the  right  and  privilege  to  receive 
during  her  girlhood  proper  instructions,  proper  food,  and  normal  devel- 
opment.    This  right  has  been  too  long  denied  the  girl. 


BEEAST    FEEDING  481 

Preparedness  seems  to  be  the  watchword  of  our  nation  in  every  de- 
partment of  industry,  since  we  have  been  watching  the  holocaust  in  Eu- 
rope, yet  I  fear  many  young  struggling  physicians  have  not  fulfilled  this 
mission  as  thoroughly  as  their  opportunities  would  permit.  The  family 
physician  has  the  rare  chance  of  moulding  the  family  tree  as  no  other 
individual  can ;  too  frequently  he  limits  his  care  to  the  ill  ones  alone.  His 
function  should  be  enlarged  to  include  personal  hygiene  of  the  young. 
I  feel  that  my  work  is  not  properly  done  when  I  neglect  careful  instruc- 
tion as  to  habits  and  feeding  of  the  growing  child  or  the  prospective 
mother.  Unfortunately,  it  is  found  in  almost  every  instance,  according 
to  my  observations,  that  errors  in  child-management  are  due  to  ignorance, 
so  I  feel  that  it  should  be  a  part  of  our  professional  duty  to  take  the  par- 
ents into  our  confidence  and  explain  why  we  wish  certain  rules  and  direc- 
tions to  be  followed.  In  this  way  we  avoid  "bending  the  twig"  and  pro- 
duce a  normal  mother.  The  ideal  mother  is  one  who  is  mentally  normal 
as  well  as  physically  normal ;  otherwise  the  product  will  be  uncertain  and 
unbalanced. 

Breast  milk  is  variable  and  uncertain  because  the  function  is  variable. 
Yet  breast  milk  is  one  of  the  most  valuable  substances — it  is  human  life, 
and  we  must  know  its  value. 

Nursing. — The  nursing  age  is  between  twenty  and  forty;  yet  I  have 
seen  a  girl  of  fifteen  and  a  woman  of  fifty-five  successfully  nurse  their 
offspring.  I  have  seen  the  society  girl  succeed  when  the  conditions  all 
seemed  to  be  against  her ;  nothing  is  impossible  to  well-directed  effort. 
Mothers  vary  greatly  in  the  duration  of  nursing;  some  can  nurse  for  two 
months,  others  five,  seven  or  nine  months.  It  is  unusual  for  both  mother 
and  child  to  remain  well  after  ten  months  of  breast  nursing.  The  best 
index  of  a  nursing  mother's  success  is  her  own  child ;  if  it  is  content  and 
shows  the  usual  gain,  the  mother  has  succeeded.  Kerley  gives  the  follow- 
ing nursing  axioms : 

A  diet  similar  to  what  the  mother  was  accustomed  to  before  the  advent  of 
motherhood  should  be  taken. 

Tliere  should  be  one  bowel  evacuation  daily. 

From  three  to  four  hours  daily  should  be  spent  in  the  open  air,  fn  exercise 
which  does  not  fatif^ue. 

At  least  eigrht  hours  out  of  every  twenty-four  should  be  given  to  sleep. 

There  should  be  absolute  regularity  in  nursing. 

There  should  be  no  worry  and  no  excitement. 

The  mother  should  be  temperate  in  all  things. 

DIET  DURING  LACTATION.— The  diet  of  a  nursing  mother  should  be 
nearly  the  same  as  the  one  she  has  been  accustomed  to  have,  provided  it 


482  KEQUIREMEXTS    OF    INFANT    FEEDING 

has  sufficient  variety  and  is  nutritious  and  digestible.  I  have  found  mothers 
attempting  to  nurse  their  children  while  following  a  restricted  diet,  omit- 
ting most  vegetables,  for  fear  of  creating  colic  in  the  infants;  this  is 
frequently  a  mistake.  A  robust  young  mother  who  has  been  accustomed 
to  indulge  in  a  full,  generous  diet  cannot  supply  her  child  on  a  restricted 
diet  without  one  or  the  other  suffering  by  so  doing.  The  withdrawal  of 
a  number  of  vegetables  from  a  nursing  mother's  diet  can  be  made  only 
on  account  of  their  indigestibility,  and  if  she  could  digest  them  be- 
fore she  was  a  mother,  she  should  be  allowed  them  during  her  nursing 
period. 

Nursing  is  a  perfe<;tly  normal  function,  and  every  woman,  with  her 
own  child,  should  be  influenced  to  carry  it  out  along  natural  lines;  the 
only  thought  she  should  magnify  is  that  two  lives  are  to  be  provided  for 
in  the  place  of  one ;  therefore  more  food  should  be  taken  to  gain  this  end 
successfully.  The  food  in  excess  should  be  fluids,  as  milk  in  some  form, 
soups  and  broths.  The  necessity  of  crowding  food  into  the  mother  varies 
according  to  the  age  of  the  child.  The  first  month,  while  the  child  is 
young,  a  restriction  of  all  fluids  may  be  found  necessary,  while  in  a  few 
months  it  will  be  found  expedient  to  feed  the  mother  between  meals. 
After  the  third  month,  in  many  cases  I  find  the  mother  will  take  eight 
ounces  of  milk,  or  the  same  quantity  of  oatmeal  gruel  or  cornmeal  gruel 
between  breakfast  and  dinner,  the  same  in  the  mid-afternoon,  and  on 
retiring  at  night. 

It  is  due  to  Dr.  Southworth's  careful  study  that  we  have  come  to  ap- 
preciate the  value  of  cornmeal  in  the  form  of  gruel  or  as  cornmeal  mush.. 
I  have  found  it  of  considerable  value  and  insist  upon  its  liberal  ingestion 
by  every  nursing  mother  when  her  supply  of  milk  seems  to  be  diminish- 
ing. The  forced  feeding  of  nursing  mothers  is  only  limited  by  her  power 
of  digestion,  and  if  any  article  seems  to  disagree,  it  is  well  to  discontinue 
the  same. 

BOWEL  MOVEMENT. — The  bowcl  movement  is  a  part  of  the  digestive 
function  and  should  be  most  carefully  watched.  One  free  evacuation 
daily  should  be  insisted  upon. 

The  treatment  of  constipation  in  nursing  mothers — a  type  of  indiges- 
tion— is  surrounded  with  difficulties.  The  dietetic  method  offers  us  little 
aid,  because  it  interferes  with  the'  milk  production.  Usually,  cooked 
fruit  and  gruels  serve  to  keep  up  peristalsis.  Abdominal  massage  is  of 
some  value.  It  is  my  request  that  every  nursing  mother  receive  an  enema 
before  retiring  if  no  evacuation  has  occurred  during  the  day.    If  the  pre- 


BREAST    FEEDING  483 

ceding  methods  have  not  succeeded,  I  have  found  the  following  pill  valu- 
able and  1  doubt  that  any  harm  has  occurred  to  the  child : 

Ex.  lihaninus  Pursli gr.   iii 

Ex.  Belladonna   gr.  ^ 


Ex.  Nux  Vom gr. 


One  at  night;  possibly  another  may  be  indicated  at  noon  the  following 
day,  if  no  action  has  taken  place.  The  pill  is  a  very  good  tonic  to  the 
intestinal  canal,  a  peristaltic  persuader. 

REGULARITY  OF  NURSING.— Kegiilarity  of  nursing  is  of  vital  impor- 
tance, for  the  child  as  well  as  the  quality  and  quantity  of  the  lacteal  secre- 
tion. The  breast  that  is  emptied  regularly  contains  a  better  quality  as 
well  as  a  larger  quantity  of  milk. 

System  and  regularity  are  as  important  in  milk  production  as  is  di- 
gestion. If  the  gradual  growth  of  the  child  is  in  keeping  with  the  age 
and  weight,  as  proved  by  the  happy  child,  I  begin  with  a  bottle  of  water 
night  and  morning,  a  very  necessary  part  of  the  feeding.  This  I  continue 
during  the  first  year.  I  have  found  many  infants  cross  and  unhappy  be- 
cause the  mothers  had  neglected  to  give  them  water  at  regular  intervals. 
Between  the  third  and  fourth  month,  I  begin  with  one  bottle  feeding 
daily.  This  is  very  essential.  In  case  of  illness  of  the  mother,  or  if  she 
is  called  away  from  the  child  by  an  unexpected  emergency,  the  child  is 
provided  for,  and  at  the  same  time  conditions  are  arranged  for  a  very 
gradual  change  from  the  breast  to  the  bottle.  This  can  be  accomplished 
within  one  year. 

DURATION  OF  WEANING.— The  average  duration  of  weaning  from 
breast  to  bottle  is  about  three  months.  I  am  generally  influenced  by  the 
health  and  temperament  of  the  mother 'in  this  matter;  commencing  at  the 
sixth  month  with  two  bottles  daily,  I  add  a  bottle  every  month  until  the 
ninth  or  tenth  month,  when  I  have  the  child  wholly  fed  by  bottle.  In 
addition  to  the  bottle  I  commence  at  the  third  month  to  give  orange  juice 
daily.  The  juice  of  one-half  of  a  large  sweet  orange  is  given  daily 
throughout  the  year.  By  the  time  the  child  is  six  months  old,  I  give  in 
addition  to  the  orange  one-half  ounce  of  beef  juice  daily.  This  I  con- 
tinue also  throughout  the  year,  increasing  in  quantity  if  I  find  it  de- 
sirable. 

It  is  usually  regarded  as  physiological  that  the  new-born  child  should 
lose  at  least  one-half  a  pound  before  breast  feeding  is  fully-  established. 
This  is  unnecessary  if  the  nurse  and  physician  are  in  accord  in  the  care- 
ful management  of  the  child.    If  one-half  to  one  ounce  tepid  sugar  water 


484  REQUIREMENTS    OF    INFANT    FEEDING 

(one  per  cent)  be  given  every  two  hours  from  birth  up  to  the  time  the 
milk  supply  is  established,  this  loss  does  not  take  place.  This  method 
carefully  carried  out  will  not  only  guard  against  loss  of  weight,  but  will 
also  anticipate  the  febrile  state  of  the  new-born,  recognized  as  inanition 
fever. 

SUCCESSFUL  NURSING. — The  evidences  of  successful  nursing  are 
many  and  should  always  be  looked  for.  The  child  should  be  quiet,  con- 
tented, and  sleep  most  of  the  time.  The  gain  in  weight  should  not  be  less 
than  four  ounces  per  week  and  frequently  over  eight  ounces  per  week, 
which  is  nearer  the  standard  gain  than  four  ounces  per  week.  Where  the 
gain  is  less  than  four  or  remains  at  four  ounces,  I  suspect  something 
wrong  with  the  nursing,  possibly  irregular  nursing,  but  more  probably 
the  fault  is  in  the  supply.  An  analysis  of  the  milk  will  give  the  answer. 
After  nursing  from  ten  to  fifteen  minutes,  the  child  should  fall  asleep  and 
remain  asleep  until  the  approach  of  the  next  period,  when  he  is  again 
ready  for  feeding.  Regularity  enforced  on  the  child  soon  establishes  reg- 
ularity in  its  demands,  and  the  mother  will  soon  govern  herself  accord- 
ingly. The  stools  under  this  carefully  regulated  feeding  are  from  two  to 
three  per  day,  smooth,  yellow,  soft,  and  almost  devoid  of  odor. 

UNSUCCESSFUL  NURSING.— Evidence  of  unsuccessful  nursing  is  too 
frequently  accounted  for  on  the  grounds  of  some  trifling  cause,  such  as 
"colds,"  fatigue,  or  defects  in  diet  in  mothers,  while  the  real  cause  may 
be  deficient  lacteal  secretion.  When  the  standard  established  for  a  normal 
well-nursed  baby  falters,  it  must  be  investigated  and  corrected  in  order 
to  maintain  good  results.  When  the  maternal  supply  is  defective,  either 
as  to  quantity  or  quality,  the  child  soon  makes  it  known  to  the  mother 
and  physician  by  becoming  troublesome,  by  crying  long  before  the  nursing 
period,  or  lingering  unduly  at  the 'breast,  endeavoring  to  extract  its  meal 
in  thirty  minutes  that  should  satisfy  it  within  half  that  length  of  time. 

The  most  prolific  cause  of  failure  in  breast  feeding  is  naturally  a 
scanty  breast  supply,  and  this  is  influenced  by  many  factors  outside  of 
the  mother  herself.  The  nearer  the  supply  is  to  the  nutritional  standard, 
the  more  satisfactory  will  be  the  progress  of  growth  and  development  of 
the  child.  It  should  contain  three  to  four  per  cent  fat ;  protein  one  to  two 
per  cent,  and  sugar  six  to  seven  per  cent.  Failure  may  be  due  to  any 
marked  deviation  of  any  one  of  the  above.  It  has  been  my  experience 
that  some  babies  will  grow  irritable  and  lose  weight  while  the  mother  is 
producing  milk  in  abundance,  but  containing  eight  per  cent  sugar.  This 
is  not,  however,  the  usual  order  of  things,  as  most  babies  have  a  good 
tolerance  for  sugar.     The  same  thing  occurs  when  the  fat  is  unduly  de- 


BREAST    FEEDING  485 

fective.  In  cases  wliere  we  iiiid  green  watery  stools,  the  cause  is  most 
probably  due  to  a  high  fat  content;  five  or  six  per  cent  fat  will  always 
induce  green  watery  bowel  movements.  In  such  cases,  the  milk  should  be 
examined;  especially  should  this  be  done  if  the  child  shows  effort  in 
defecation  or  vomiting. 

Low  fat  content  usually  brings  about  constipation  and  defective  nour- 
ishment. The  protein  of  breast  milk  has  been  regarded  as  the  most  im- 
portant element  to  consider  and  the  one  requiring  the  most  careful  study, 
irregularities  being  sure  to  bring  about  some  gastric  or  intestinal  trouble. 
Increase  of  protein  will  cause  colic  and  constipation.  In  such  cases  we 
will  find  curds,  pain  associated  with  gas,  and  frequently  with  fever,  and 
occasionally  vomiting.  The  mother  may  produce  a  normal  amount  of 
fat,  sugar  and  protein,  but  not  sufficient  to  satisfy  the  child's  hunger. 
The  child  may  require  four  or  five  ounces  and  the  breast  may  only  pro- 
duce half  the  quantity.  The  only  trustworthy  guide  in  this  condition 
is  to  weigh  the  child  before  and  after  each  nursing  for  at  least  twenty- 
four  hours.  One  ounce  of  breast  milk  weighs  nearly  one  ounce  avoirdu- 
pois. This  method  gives  us  the  quantity  but  not  the  quality.  Mistakes 
in  quantity  are  frequently  made  by  faulty  weighing.  The  child  should 
be  most  carefully  weighed  in  the  same  clothing,  or,  better,  with  as  little 
clothing  as  possible,  to  insure  accuracy. 

Consideration  of  Breast  Milk — The  quality  of  the  mother's  milk  is  of 
vital  moment.  It  should  be  determined  at  regular  intervals.  (This  will  be 
discussed  later  on.)  It  is  interesting  to  observe  that  children  gain  after 
each  meal  from  one  ounce  in  weight  up  to  eight  or  nine  ounces,  according 
to  the  age — thus  a  child  under  one  week  will  gain  from  one  to  one  and  a 
half  ounces  per  meal  of  fifteen  minutes ;  four  to  eight  weeks  old,  a  gain  of 
two  to  three  ounces ;  sixteen  to  twenty-four  weeks  old,  four  to  six  ounces ; 
and  nine  to  twelve  months  of  age,  eight  to  nine  ounces.  This  is  not  an  ab- 
solutely fixed  quantity,  nor  do  we  find  many  mothers  producing  so  large  a 
quantity  at  the  end  of  the  year.  When  a  child  is  unhappy,  unsatisfied,  and 
no  other  physical  reasons  to  be  found,  I  generally  institute  a  milk  analy- 
sis ;  this  is  especially  indicated  when  the  weight  is  slowly  gained  or  if  it 
remains  stationary.  Weighing  the  baby  once  a  week  is  the  only  true 
method  of  procedure.  Ofttimes  a  child  is  unhappy  from  excess  of  good 
milk;  usually  it  is  taken  too  fast,  when  it  is  regurgitated  or  produces 
colic.     It  is  more  frequently  tolerated  for  a  long  time. 

In  the  presence  of  dilated  stomach,  habitual  vomiting  (ofttimes  re- 
garded as  a  healthy  sign  by  mothers)  and  constipation,  the  child  loses  in 
weight  and  may  be  weaned  from  a  good  breast  to  the  bottle.    This  unfor- 

131 


486  KEQUIKEMENTS    OF   INFANT    FEEDING 

tunate  result  could  be  avoided  if  the  physician  were  consulted  early  and 
proper  feeding  rules  established. 

The  rule  in  such  cases  is  to  weigh  the  baby  before  and  after  feeding, 
and  have  the  milk  carefully  examined.  A  nursing  infant  may  suffer 
from  habitual  indigestion,  while  its  mother  may  have  unusually  good 
breast  milk;  here  the  child  can  be  greatly  benefited  by  shortening  the 
time  at  the  breast.  Weighing  the  baby  at  intervals  of  three  to  five  min- 
utes and  recording  the  gain,  reveals  an  intake  of  three  to  four  ounces, 
which  may  represent  the  capacity  of  the  child's  stomach,  the  excess  which 
the  child  obtains  over  this  amount  being  the  cause  of  the  trouble.  From 
a  free  full  breast  a  vigorous  nurser  will  take  one  ounce  in  one  minute. 
Some  infants  completely  fill  the  stomach  within  five  minutes,  and  will 
safely  hold  its  contents,  but  they  must  not  be  handled  after  the  meal,  if 
we  wish  them  to  retain  the  food ;  this  rule  is  a  personal  equation. 

When  we  fear  the  child's  "speed,"  we  must  adjust  the  environments 
accordingly.  Mothers  must  be  informed  that  their  babies  cannot  nurse 
as  long  as  they  wish,  or  as  often  as  they  cry.  Such  habits  encouraged 
early  are  certain  to  ruin  the  strongest  digestion  later  in  the  child's  life. 
Frequently  a  mother  may  have  sufiicient  quantity  of  milk,  the  child 
thrives,  may  not  vomit  or  show  any  signs  of  indigestion,  yet  not  continue 
to  put  on  weight. 

Only  repeated  examinations  will  finally  show  that  the  mother's  milk 
lacks  either  fats  or  proteins.  This  may  occur  frequently  and  is  best 
explained  by  finding  the  mother  irregular  in  her  own  feeding,  or  person- 
ally neglectful  in  some  other  way.  Strenuous  personal  hygiene  on  the 
mother's  part  may  prevent  the  irregularity,  and  if  the  fats  and  proteins 
cannot  be  increased,  the  bottle  must  come  to  the  rescue. 

This  failure  on  the  mother's  part  leads  us  to  mention  the  signs  of 
insufficient  nursing,  as  revealed  when  the  child  lingers  long  at  the  breast, 
perhaps  for  thirty  minutes  or  more,  and  cries  or  shows  signs  of  discom- 
fort when  removed.  Within  an  hour  the  child  cries  and  shows  all  the 
evidence  of  hunger.  He  will  also  demand  frequent  nursing  during  the 
night.  If  this  condition  continues,  the  child  will  not  gain,  but  actually 
lose  in  weight.  The  remedy  for  insufficient  milk  must  be  given  before 
the  failure  takes  place,  that  is,  every  physical  condition  of  the  expectant 
mother  must  be  carefully  inquired  into,  examined  and  corrected  before 
the  baby  comes,  and  after  its  arrival,  every  unfavorable  condition  must 
be  carefully  ascertained  and  removed.  Emotional  women  are  prone  to 
irregularity  in  their  milk  supply,  hence  prospective  mothers  of  this  class 
should  be  most  carefully  watched. 


BREAST    FEEDING  487 

LACK  OF  UNIFORMITY  IN  BREAST  MILK.— We  are  frequently  con- 
fronted with  irregular  or  abnormal  milk  production  in  the  nursing 
mother.  No  mother  has  a  uniform  milk;  it  varies  from  day  to  day,  and 
from  month  to  month,  rich  in  fats  and  proteins  at  one  month  and  less  in 
another ;  these  variations  do  not  affect  the  child  unless  they  are  continuous 
and  most  marked.  When  it  is  found  that  the  milk  is  too  strong  in  fats 
and  proteins,  or  when  the  ratio  is  not  maintained,  it  is  possible,  by  care- 
ful dieting,  to  diminish  the  milk  strength,  or,  if  it  is  found  necessary, 
to  increase  the  fat  or  protein  content.  The  richer  milk  is  usually  found 
in  young  mothers  who  are  athletic  and  robust,  who  eat  well  and  whose 
digestion  is  normal.  In  nursing  mothers  of  a  sedentary  type,  a  daily 
bath  and  massage,  with  restriction  of  the  rich  food,  cutting  out  red  meats, 
or,  at  best,  allowing  but  a  small  quantity  daily,  and  the  withdrawal  of 
all  forms  of  wines  or  alcohol,  will  accomplish  much  good.  The  mother 
should  be  directed  to  walk  from  two  to  three  miles  daily  to  bring  her  milk 
to  the  proper  digestible  condition  for  her  infant.  If  the  dieting  and  walk- 
ing fail  to  adjust  the  milk  output,  it  has  been  my  practice  to  order  the 
child  to  have  one  ounce  of  boiled  water  containing  a  small  quantity  (one 
dram)  of  soda  mint,  immediately  before  each  nursing.  Ofttimes  I  find 
it  well  to  give  in  the  place  of  the  boiled  water  the  same  quantity  of  barley 
water. 

Giving  barley  water,  boiled  water  or  lime  water — one-half  ounce  to 
one  ounce — is  a  frequent  procedure  in  my  practice,  often  leading  to  good 
results.  This  simple  dietetic  advice  is  too  frequently  neglected,  and 
should  be  more  generally  known  and  practiced.  This  easy  rule  has  been 
the  means  of  saving  many  lives  in  my  hands,  for  it  has  made  breast  feed- 
ing possible. 

DEFICIENCY  IN  PROTEINS  AND  FATS.— When  the  milk  is  deficient  in 
fats  and  proteins,  we  must  push  a  full  diet  of  more  concentrated  food. 
In  these  cases  I  find  Dr.  Southworth's  methods  of  feeding  cornmeal  mush 
or  cornmeal  gruel,  to  the  mother,  of  value.  This  procedure  is  especially 
valuable,  and  readily  available,  when  the  patient  is  fond  of  corn  prod- 
ucts, which  so  many  patients  dislike,  so  that  we  fail  to  gain  good  results 
because  the  mothers  do  not  willingly  partake  of  the  corn  in  any  form 
sufficiently  to  gain  an  increase  in  their  milk.  I  have  seen  a  number 
of  mothers,  however,  who  have  been  most  decidedly  benefited  by  this  ad- 
dition to  their  dietary.  In  addition  to  the  cornmeal  gruel  and  mush,  I 
urge  the  free  taking  of  meat,  fish,  whole  wheat  bread,  oatmeal,  and  plenty 
of  milk  in  a  variety  of  forms,  junket,  custard,  etc.,  which  will  insure  an 
increase  of  both  fat  and  protein.    The  use  of  malt  liquors  in  a  moderate 


488  KEQUIREMENTS    OF    INFANT    FEEDING 

quantity,  as  porter  sangaree,  or  brown  stout,  will  increase  the  fat  content 
of  a  mother's  milk.  However,  after  all,  we  are  frequently  disappointed 
in  our  very  best  efforts  to  improve  the  quantity  or  quality  of  breast  milk. 

Mixed  Feeding — All  breast-fed  infants  must  be  taught  to  take  the 
bottle  by  the  third  month ;  the  bottle  must  be  familiar  to  the  child  by  this 
time,  or  we  will  fail  in  our  efforts.  It  is  absolutely  necessary  for  success 
later  in  the  first  year.  It  may  contain  nothing  but  water,  yet  the  bottle 
must  be  given  early  in  life.  Even  with  the  best  nursing  breasts,  I  find 
it  necessary  to  commence  with  a  bottle  of  modified  milk  by  the  sixth 
month,  sometimes  waiting  till  the  seventh  or  eighth  month. 

By  this  time  the  vigor  of  the  child  demands  more  protein  and  the 
mother  usually  possesses  less,  so  that  the  modified  bottle  is  a  welcomed 
necessity.  From  this  time  on,  I  increase  the  bottle  by  one  per  week  until 
the  tenth  month,  when  the  child  is  wholly  weaned  from  the  breast  to  the 
bottle.  Few  women  can  produce  sufiicient  nourishment  for  a  gro.wing 
child  after  ten  months,  hence  I  find  the  best  of  mothers  are  willing  to 
wean  their  child  by  this  time.  All  children  should  be  on  the  bottle  from 
the  tenth  or  at  most  the  twelfth  month,  until  they  learn  to  chew  food, 
that  is,  until  they  are  two  or  three  years  old.  Sucking  is  to  the  infant 
what  chewing  is  to  the  adult,  a  necessary  requisite  to  good  digestion.  I 
never  deprive  the  infant  of  the  bottle;  indeed  many  of  my  children  have 
found  comfort  and  food  in  this  way  until  they  are  five  and  even  six  years 
old. 

All  nursing  infants,  in  addition  to  the  first  bottle  at  three  months  of 
age,  can  also  be  given  one  tablespoonful  of  orange  juice  per  day,  with 
or  without  water.  At  the  sixth  month,  in  addition  to  this  orange  juice, 
beef  juice  in  the  same  quantity  can  be  given.  This  is  continued  daily 
until  weaning  occurs.  When  a  mother  fails  to  give  her  infant  two  com- 
fortable feedings  per  day,  it  is  time  to  wean  the  child,  and  further  nurs- 
ing by  the  mother  is  forbidden. 

Contra-Indications  to  Breast  Feeding. — A  mother  must  not  nurse  her 
infant  when  she  has  a  fever  from  any  cause.  She  cannot  nurse  if  she 
shows  any  manifestation  of  active  tuberculosis.  Few  mothers  will  be 
found  entirely  free  from  tubercular  implantation,  yet  so  long  as  it  is  not 
active,  we  cannot  deprive  them  of  this  important  duty.  If  any  form  of 
glandular  or  joint  infection  should  exist,  we  must  prevent  nursing. 

Syphilis  and  epilepsy  also  counterindicate  maternal  nursing.  In  ad- 
vanced nephritis  or  any  malignant  gro\^'th,  the  breast  is  withheld ;  the 
same  is  also  true  in  acute  diseases,  such  as  pneumonia  and  typhoid  fever 
or  diphtheria. 


ARTIFICIAL    FEEDING    OF    INFANTS  489 

ARTIFICIAL    FEEDING    OF    INFANTS 

Inasmuch  as  the  milk  of  the  cow  is  the  most  couvenient  and  cheapest, 
it  is  usually  selected  as  the  food  for  the  infant  when  the  mother's  breast 
fails  to  sustain  it.  Cow's  milk  should  not  be  selected,  however,  until 
every  effort  on  the  part  of  the  mother  has  been  exhausted.  The  most 
important  consideration  in  the  selection  of  cow's  milk  for  the  infant  is 
certainly  its  cleanliness.  This  factor,  fortunately,  has  been  thoroughly 
impressed  on  the  public.  In  the  country  and  small  towns  there  is  no 
difficulty  in  obtaining  clean  milk,  provided  the  ordinary  rules  of  stable 
hygiene  and  cleanliness  on  the  part  of  milkers  and  handlers  of  the  milk 
are  observed.  The  personal  attention  of  the  physician  must  be  directed 
to  this  side  of  the  milk  problem  if  he  is  to  hope  for  success  with  his  young 
charges.  In  large  cities  the  milk  question  becomes  more  difficult,  as  the 
milk  has  to  be  carried  long  distances,  pass  through  several  hands,  and  the 
time  is  much  longer  between  the  milking  and  the  time  the  child  receives 
the  milk.  Clean  raw  cow's  milk  is  the  best  food  (next  to  the  mother's 
breast)  for  the  child.  In  recent  years,  the  superiority  of  clean  raw  milk 
to  any  other  artificial  food  is  being  more  fully  recognized  by  all  pediatri- 
cians, so  that  a  most  strenuous  effort  has  been  made  to  obtain  it  in  all 
our  larger  cities.  Through  the  teaching  of  the  late  Dr.  Rotch  of  Harvard, 
the  Walker  Gordon  Laboratories  became  the  pioneer  for  the  use  of  clean 
raw  milk. 

Certified  Milk — To  the  late  Dr.  Coit  of  New  Jersey  is  due  the  per- 
fection of  methods  to  produce  certified  milk  as  now  furnished  to  the 
public  in  most  of  the  larger  cities.  The  education  of  the  public  along 
these  lines  for  a  pure  clean  milk  has  resulted  in  the  establishing  of  model 
dairy  farms  near  all  cities,  so  that  the  transporting  of  the  milk  can  be 
effected  promptly. 

The  rules  that  should  prevail  and  must  be  recognized  by  the  public 
are  as  follows: 

The  cows  must  be  kept  clean  and  healthy,  especially  free  from  tuberculosis; 
the  stables  must  be  clean  and  sanitary,  free  from  flies;  the  stable  yards  free  from 
manure  or  stagnant  water;  the  water  supply  for  dairy  purposes  should  be  clean 
and  pure;  the  food  for  the  cows  should  be  free  from  noxious  weeds  or  distillery 
slops.  The  cows  should  be  cleaned  by  daily  grooming,  and  the  milking  should  be 
done  with  clean  hands,  from  clean  udders  into  clean  pails,  thus  using  ever\'  effort 
to  prevent  the  early  contamination  of  the  milk.  The  first  flow  of  milk  from  the 
udder  should  be  discarded  as  unsafe.  After  milking,  the  milk  should  be  immedi- 
ately removed  to  a  separate  or  adjoining  building,  strained  and  cooled,  bottled 
and  placed  in  a  refrigerator,  retained  here  until  it  is  sent  to  the  consumer.     In 


490 


EEQUIREMENTS    OP   IKFANT    FEEDI:N"G 


transporting  the  milk  it  should  be  kept  cool  and  should  reach  the  consumer  with 
a  bacterial  content  not  above  10,000  to  the  c.c. 

If  milk  can  be  furnished  to  the  home  in  the  above  condition,  it  is  per- 
fectly safe  to  feed  the  infant  in  a  raw  state.  In  this  way  the  vital  prin- 
ciple of  the  milk  is  retained,  and  this  is  the  ideal  food,  retaining  the  vita- 
mines,  of  which  further  mention  will  be  made. 

COMPARATIVE  ANALYSIS  OF  WOMAN'S  AND  COW'S  MILK 


Constituents 

Average  Woman 

Average  Cow 

Protein 

1.50 
3.50 
7.00 
0.20 

87.80 

3.50 

Fats 

4.00 

Sugar 

4.50 

Salts 

0.75 

Water 

87.25 

There  are  decided  differences  in  mother's  and  cow's  milk  which  are 
not  apparent.  Mother's  milk  contains  ferments  which  stimulate  digestive 
secretions  in  the  infant,  while  those  of  cow's  milk  stimulate  the  digestion 
in  the  calf,  not  the  infant. 

COMPARATIVE  COMPOSITION  OF  MILKS  OF  DIFFERENT  ANIMALS 

(Voltz)    (41) 


Milk 


Water 


Solids 


Fat 


Casein 


TotalN. 


Sugar 


Ash 


Human 

Cow 

Buffalo 

Zebu  (1  analysis). . . 

Llama  (3  analyses) . 

Camel  (7  analyses) . 

Goat 

Sheep 

Reindeer 

Mare 

Donkey 

Elephant 

Hippopotamus  (1 
analysis) 

Rabbit  (1  analysis) 

Guinea  pig  (1  an- 
alysis)   

Dog  (8  analyses) . . . 

Cat 

Pig 

Blue  whale 


87.58 
87.80 
82.30 
86.13 
86.55 
87.60 
86.30 
81.50 
67.70 
90.58 
90.12 
67.85 

90.43 
69.50 

41.11 
77.00 
81.64 
82.37 
50.47 


12.42 
12.20 
17.70 
13.87 
13.45 
12.40 
13.70 
18.50 
32.30 
9.42 
9.88 
32.15 

9.57 
30.50 

58.89 
23.00 
18.36 
17.63 
39.53 


3.74 
3.40 
7.70 
4.80 
3.15 


17.10 
1.14 
1.37 

19.57 

4.51 
10.45 

45.80 
9.26 
3.33 
6.44 

20.00 


0.80 
2.70 


3.00 
2.98 
3.60 
4.30 


0.79 


4.15 
3.11 


2.01 
3.40 
4.80 
3.03 
3.90 

4.60 
5.60 
10.90 
2.50 
1.85 
3.09 


15.54 

11.19 
9.72 
9.53 
6.09 

12.42 


6.37 
4.70 
4.40 
5.34 
5.60 
3.26 
4.30 
5.00 
2.80 
5.87 
5.19 
8.84 


1.95 

1.33 
3.11 
4.91 
4.04 
5.63 


0.3 

0.7 

0.8 

0.7 

0.8 

0.7 

0.8 

0.9 

1.50 

0.36 

0.47 

0.65 


2.56 

0.57 
0.91 
0.59 
0.59 
1.48 


(42) 
(43) 
(43) 
(42) 
(42) 
(44) 
(43) 
(43) 
(45) 
(43) 
(43) 
(46) 


(42) 

(42) 
(42) 
(47) 
(46) 
(48) 


ARTIFICIAL    FEEDING    OF    INFANTS 


491 


Health  boards  of  some  cities,  stimulated  by  our  medical  societies,  now 
have  chemists  and  bacteriologists  whose  duty  it  is  to  make  frequent  ex- 
aminations of  the  milk  supply  as  it  is  delivered  to  the  consumer.  These 
examinations  are  for  the  determination  of  the  bacterial  contents  of  the 
milk,  the  amount  of  butter-fat,  the  relative  percentage  of  its  various  in- 
gredients, the  possible  presence  of  chemical  preservatives,  or  possibly 
any  foreign  matter. 

When  a  milk  dealer  continues  to  furnish  his  customers  with  this  ideal 
standard,  he  is  entitled  to  receive  labels  from  the  board  of  health  contain- 
ing the  words  "Certified  Milk."  These  labels,  "certified  milk,"  when 
placed  on  a  bottle,  are  his  guarantee  to  the  consumer  that  the  contained 
milk  conforms  in  all  respects  to  the  standard  laid  down  by  the  medical 
or  health  authorities.  This  "certified  milk,"  which  is  sold  in  nearly  all 
our  cities,  conforms  to  the  following  standard: 

Free  from  pathogenic  bacteria,  or  a  bacterial  content  not  exceeding  10,000  to 
the  c.c. ;  freedom  from  dirt  and  all  foreign  organic  matter;  freedom  from  chemical 
preservatives;  and,  most  important,  a  constant  nutritional  value  with  about  four 
per  cent  of  fat  and  a  full  average  of  protein  and  carbohydrates. 

With  this  medical  supervision  of  our  milk  supply,  we  have  a  nearly 
certain  food  for  children  compelled  to  be  fed  artificially.  This  careful 
precaution  necessarily  demands  an  unusual  outlay  of  money  by  every 
city,  and  as  a  result  such  milk  must  be  sold  at  a  price  to  warrant  the 
dairyman  to  continue  his  high  standard.  The  price  of  "certified  milk" 
is  therefore  prohibitive  to  the  very  poor  of  our  large  cities. 

For  this  reason  a  second  grade  of  milk  is  furnished  in  many  of  our 
cities  by  the  same  dairies  and  under  the  same  supervision  of  milk  inspec- 
tors known  as  "inspected  milk,"  and  it  bears  a  label  testifying  to  its  rela- 
tive cleanliness.  "Tested  milk"  differs  from  "certified  milk"  only  in 
the  bacterial  content.  During  the  winter  months  the  "tested  milk"  must 
not  contain  more  than  60,000  bacteria  to  the  c.c,  and  during  the  summer 
months  not  more  than  100,000  to  the  c.c.    In  all  other  bacteriological  and 

CHEMICAL  COMPOSITION  OF  COW'S  MILK 


Cow's  Milk 

Specific 
Gravity 

Water 

Casein 

Albumin 

Total 
protein 

Fat 

Lactose 

Ash 

Min 

1.026 
1.037 
1.031 

80.32 
90.32 

87.27 

1.79 
6.29 
3.03 

0.25 
1.44 
0.53 

2.07 
6.40 
3.20 

1.67 
6.47 
3.64 

2.11 
6.12 

4.88 

0.55 

Max 

1.21 

Aver 

0.71 

492 


EEQUIKEMENTS    OF   INFANT    FEEDING 


chemical  standards,  it  is  of  the  same  value  as  "certified  milk"  and  sells 
a  few  cents  cheaper  by  the  quart.  The  chemical  quantitative  and  quali- 
tative difference  between  human  and  cow's  milk  has  already  been  empha- 
sized. The  table  on  page  491  from  Leach  shows  the  composition  of  cow's 
milk. 

The  following  table  shows  how  much  the  composition  of  the  morning 
and  evening  milk  may  vary.  These  figures  are  the  average  from  29,707 
tests  of  milk  made  by  Droop  Richmond  in  England: 

VARYING  COMPOSITION  OF  MORNING  AND  EVENING  MILKS 


Milking 

Fat 
per  cent 

Lactose 
per  cent 

Protein 
per  cent 

Ash 
per  cent 

Solids 
per  cent 

Morning 

Evening 

3.44 
3.90 

4.71 
4.69 

3.43 
3.39 

0.74 
0.73 

12.34 
12.71 

Composition  of  Cow's  Milk — Cow's  milk  is  never  uniform  in  its  com- 
position. It  differs  even  in  the  same  cow  morning  and  night,  winter  and 
summer.  (See  table.)  The  composition  of  the  milk  of  a  single  cow  may 
differ  considerably  from  that  of  an  entire  herd.  It  is  fot  this  reason  that 
the  milk  of  a  herd  of  cows  is  to  be  preferred  for  general  purposes  to  that 
of  a  single  cow.  However,  when  it  comes  to  the  recognition  of  tubercular 
infection,  we  can  detect  it  in  one  diseased  cow  much  sooner  than  in  a  herd. 
The  composition  of  milk  varies  in  different  types  of  cows,  some  cows  being 
better  providers  for  human  infants  than  others ;  but  all  cows  have  milk 
for  calves,  not  for  children.  The  Guernsey  and  Jersey  cows  furnish  a 
milk  richer  in  fat,  frequently  over  five  per  cent.  The  Holstein  breed  fur- 
nishes a  less  perfect  emulsion  of  fat.  The  Durham  and  Devon  cows  yield 
a  good  rich  milk,  and  when  properly  cared  for  provide  good  safe  food  for 
the  young  infant. 

Cow's  milk  is  an  opaque  emulsion  of  fat  in  solution.  The  vehicle  is 
albuminous,  containing  lactose  and  mineral  matter.  The  color  is  yellow- 
ish white.  The  odor  is  not  strikingly  characteristic,  unless  the  cow  has 
been  feeding  on  rank  weeds  or  garlic,  or  is  suffering  from  disease.  The 
specific  gravity  at  60°  F.  varies  from  1,029  to  1,034,  the  difference  de- 
pending on  the  composition  of  the  milk.  The  reaction  is  amphoteric 
when  the  milk  is  strictly  fresh.  It  becomes  acid  by  exposure  and  the  mul- 
tiplication of  the  lactic  acid  bacillus,  and  the  acidity  increases  with  age. 
The  addition  of  preservatives  increases  the  alkalinity. 


AKTIFICIAL    FEEDING    OF    INFANTS  493 

FAT.— The  fat  of  cow's  milk  contains  stearin,  olein  and  palmitin, 
which  are  volatile  and  readily  decomposed.  When  milk  stands  for  a  short 
time,  the  fat,  being  the  lighter,  comes  to  the  surface  and  is  known  as 
cream.  The  fact  that  about  four  per  cent  of  fat  is  found  in  human  and 
cow's  milk  requires  us  to  analyze  the  two  forms  of  fat  more  closely. 
Cow's  milk  contains  a  greater  percentage  of  volatile  fatty  acids,  and  a  less 
percentage  of  oleic  acid  than  human  milk,  and  the  fat  in  the  former  is  in 
a  coarser  emulsion  and  separates  more  easily  than  in  human  milk.  The 
difference  in  the  composition  of  the  fats  of  the  two  milks  may,  in  part, 
explain  the  fact  that  the  human  infant  can  digest  and  assimilate  four  per 
cent  of  fat  in  woman's  milk,  and  yet  fail  to  digest  two  per  cent  of  fat  in 
cow's  milk,  and  it  may  also  explain  why  cow's  milk,  with  its  excess  of 
volatile  fatty  acids,  may  predispose  to  acid  intoxications  in  infancy,  since 
these  acids  are  readily  converted  by  hydrolysis  into  acetic  acid  and  acetone. 

PROTEINS.— The  chief  proteins  of  milk  are  casein  and  lactalbumen; 
lactoglobulin,  lacto-protein  and  nuclein  occur  in  smaller  quantities.  Whey 
protein  contains  all  the  proteins  of  milk,  except  the  casein.  In  woman's 
milk,  the  whey  protein  exceeds  the  casein  in  the  proportion  of  two  to  one, 
but  in  cow's  milk  the  proportion  is  as  one  to  six.  Chemistry  has  not  as 
yet  established  any  difference  between  the  whey  proteins  of  cow's  milk 
and  woman's  milk,  but  these  two  milks  are  entirely  different  in  the  quan- 
tities of  casein  and  soluble  albumins  they  contain.  The  difference  most 
important  to  the  clinician  is  the  chemistry  of  the  two  caseins.  This  dif- 
ference is  practical  and  concerns  the  manner  of  their  reaction  to  the  same 
ferments  and  reagents. 

In  the  stomach  of  the  human  infant,  the  calcium  casein  of  cow's  milk 
(the  form  in  which  casein  exists  in  cow's  milk)  is  readily  precipitated 
by  rennet,  in  the  presence  of  a  slight  amount  of  acid,  into  a  clot  of  calcium 
paracasein,  and  later,  as  the  hydrochloric  acid  is  secreted  in  larger  quan- 
tities, into  hydrochlorate  of  paracasein  and  calcium,  the  calcium  being 
separated  from  the  paracasein  clot  by  the  hydrochloric  acid.  This  clot  is 
larger  and  tougher  than  the  clots  which  occur  in  the  infant's  stomach  from 
the  action  of  the  same  reagent  on  human  milk. 

In  human  milk  the  paracasein  clots  and  the  hydrochlorate  of  para- 
casein clots  are  softer  and  lighter — more  flocculent,  as  compared  with 
those  of  cow's  milk.  In  artificial  feeding,  casein  is  most  frequently 
blamed  for  disturbing  the  child's  digestion.  To  increase  or  diminish  the 
percentage  of  casein  content  in  the  bottle  of  an  infant  was  supposed  to 
alter  the  digestive  injury.  This  practice  has  been  discovered  a  griev- 
ous mistake,  as  the  casein  is  very  rarely  the  cause  of  intestinal  trouble. 


494  EEQUIREMENTS    OF    INFANT    FEEDING 

The  most  frequent  types  of  food  injury  are  due  to  the  sugar  or  fat  con- 
tent. 

Finkelstein  and  Meyer  have  demonstrated  that  intestinal  indigestion 
may  be  improved,  if  not  controlled,  by  increasing  the  casein  content  and 
diminishing  the  fat  and  sugar  in  the  milk.  The  digestibility  of  the  casein 
of  cow's  milk  depends  largely  on  the  presence  or  absence  of  the  condition 
of  the  child's  stomach  which  causes  its  precipitation  in  small  or  large 
clots.  Casein  is  very  easily  digested  and  assimilated  if  large  clot  forma- 
tion can  be  prevented. 

If  an  alkali  be  added  to  the  cow's  milk  before  it  enters  the  stomach, 
such  as  sodium  citrate,  sodium  bicarbonate,  or  even  lime  water,  large  clot 
formations  may  be  avoided.  Hydrochloric  acid  or  lactic  acid  will  also 
accomplish  the  same  result.  The  alkali  or  the  acid  combines  with  the 
casein  and  breaks  up  large  clot  formations.  This  it  does  by  interfering 
with  the  action  of  the  rennet;  rennet  can  only  act  in  the  presence  of  a 
slightly  acid  medium. 

The  value  of  boiling  milk,  as  is  frequently  necessary  during  hot 
weather,  is  clearly  seen  by  this  formation  of  small  clots ;  hence  its  double 
value  by  killing  bacteria  and  rendering  the  milk  more  digestible.  It  may 
be  necessary  to  reduce  the  fat  in  the  milk  temporarily,  so  as  to  prevent 
its  entanglement  in  the  meshes  of  the  clot.  The  danger,  therefore,  in  the 
high  percentage  of  casein  feeding  is  that  we  may  not  be  able  to  control  the 
cause  of  clot  formation. 

The  human  infant  may  digest  the  various  food  elements  of  cow's  milk 
when  they  are  held  in  the  whey  of  human  milk  and  may  fail  to  digest 
them  in  the  whey  of  cow's  milk.  Any  food  for  the  young  infant  that 
does  not  maintain  the  usual  casein  content  is  absolutely  wrong.  The 
casein  of  cow's  milk  contains  53  per  cent  of  carbon,  16.65  per  cent  nitro- 
gen, T.08  per  cent  of  hydrogen,  and  0.85  per  cent  of  phosphorus.  This 
composition  of  proteins  with  the  large  per  cent  of  nitrogen  content  makes 
them  actually  necessary  for  all  growth  and  all  life. 

CARBOHYDRATES. — The  carbohydrate  content  in  cow's  milk  is  4  per 
cent;  in  human  milk  it  is  7  per  cent.  Lactose  is  the  only  carbohydrate 
found  in  milk.  The  variation  in  quantity  of  this  sugar  from  day  to  day 
and  with  the  age  of  the  infant  is  surprisingly  small.  Fats  and  proteins 
vary  from  day  to  day  and  according  to  the  condition  of  the  mother,  but 
the  sugar  scarcely  changes.  Milk  sugar  in  human  milk  is  especially  ad- 
justed to  supply  carbohydrate  food  to  the  young  infant.  It  does  not  easily 
ferment  and  is  quickly  converted  into  dextrose  in  the  intestines.  German 
pediatricians,  however,  regard  milk  sugar  as  the  most  common  cause  of 


ARTIFICIAL    FEEDING    OF    INFANTS  495 

intestinal  fermentation.  It  seems  that  milk  sugar  when  held  in  the  whey 
of  cow's  milk  is  less  rapidly  absorbed  and  more  frequently  augments  fer- 
mentation than  maltose  or  dextrin.  The  majority  of  normal  infants  can 
readily  digest  sugar. 

Sugar  next  to  albumins  is  the  most  important  food  of  the  infant. 
Like  the  fats,  sugar  serves  as  a  fuel  for  the  production  of  heat,  and  sup- 
plies the  food  which  furnishes  energy  to  the  growing  cells.  In  their  heat- 
forming  capacity,  carbohydrates  are  second  to  the  fats,  but  in  their  energy 
power  they  are  most  important.  It  is  an  interesting  physiological  fact 
that  the  oxygen  contained  in  the  carbohydrates  is  not  only  sufficient  to 
oxidize  their  own  hydrogen,  but  to  aid  materially  in  oxidizing  the  waste 
products  of  the  fat  and  protein  molecules  as  they  are  broken  down  in  the 
body,  thus  preventing  an  auto-intoxication.  This  is  a  beautiful  fact 
pressed  home  on  us  all  as  an  illustration  of  the  interdependence  of  the 
protein,  fat  and  carbohydrate  molecules  in  serving  the  nutritional  de- 
mands of  the  body,  and  makes  very  plain  the  truth  that  we  act  wisely  and 
according  to  nature's  lead  when  we  imitate  nature  in  making  an  infant 
food  by  combining  these  food  elements  in  proper  proportions. 

Clinically  the  physician  soon  expects  trouble  when  the  food  elements 
are  not  kept  in  their  natural  proportion ;  thus  an  excess  of  carbohydrates, 
with  other  food  elements,  especially  the  fats,  in  normal  proportions,  may 
result  in  diarrhea,  loss  of  weight,  fever,  and  generally  a  catarrh  of  the 
digestive  tube.  An  excess  of  carbohydrates  with  other  food  elements  be- 
low the  normal  may  result  in  anemia,  rickets  and  malnutrition.  A  severe 
food  injury  may  arise  by  overtaxing  the  digestive  capacity  when  we  have 
a  deficiency  in  carbohydrates  with  the  other  food  elements  in  excess. 

INORGANIC  CONTENTS.— The  ordinary  inorganic  constituents  of  milk 
are  calcium,  sodium,  potassium,  magnesium,  phosphorus  and  iron.  All 
of  the  above,  except  iron,  are  present  in  both  human  and  cow's  milk  in 
sufficient  quantities  to  meet  the  nutritional  demands  of  the  growing  in- 
fant. The  hemoglobin  contains  iron  as  a  very  necessary  constituent  to 
the  oxidation  process  which  underlies  body  metabolism.  The  deficiency 
of  iron  in  milk,  which  gradually  increases  as  lactation  proceeds,  is  made 
up  in  the  first  year  of  life  from  the  iron  found  in  the  liver  and  other 
organs  of  the  new-born  infant.  It  is  found  that  at  birth  there  exists  as 
much  iron  in  proportion  to  body  weight  as  in  adults.  The  partial  iron 
starvation  which  necessarily  occurs  on  a  milk  diet  is  not,  therefore,  of 
material  consequence  during  the  first  year  of  life.  As  the  child  grows 
older,  the  storehouse  of  iron  becomes  exhausted  and  it  is  necessary  to 
supplement  the  milk  diet  by  such  iron-containing  foods  as  fruit  juices, 


496 


KEQUIREMENTS    OF    INFANT    FEEDING 


eggs,  purees  of  vegetables  and  broths ;  otherwise  anemia  and  malnutrition 
may  result. 

It  is  true  that  the  other  inorganic  constituents  play  a  no  less  important 
role  than  iron  in  the  body  metabolism  of  the  human  infant.  All  those  I 
have  mentioned  are  found  in  such  organic  combination  in  human  milk 
as  to  be  readily  assimilated  in  sufficient  quantities  to  meet  nutritional  de- 
mands. A  healthy  infant  can  usually  assimilate  a  sufficient  quantity  of 
the  inorganic  constituents  of  cow's  milk.  The  fact  that  a  smaller  quantity 
by  percentage  of  the  salts  of  cow's  milk  is  assimilated  is  offset  by  the  fact 
that  they  occur  in  larger  quantities  in  cow's  milk  than  in  human  milk. 

In  certain  pathological  conditions,  however,  the  failure  of  the  human 
infant  to  assimilate  the  salts  of  cow's  milk  produces  serious  disorders  of 
nutrition  and  frequently  becomes  a  factor  in  the  production  of  wasting 
or  atrophy.  The  frequent  practice  of  adding  lime  water,  sodium  bicarb, 
or  sodium  chlorid,  or  better,  sodium  citrate  to  cow's  milk,  not  only  pro- 
motes the  digestion  and  absorption  of  casein,  but  also  facilitates  the  ab- 
sorption of  the  mineral  salts  of  the  milk,  this  being  especially  true  of 
calcium.     The  following  table  is  taken  from  various  sources: 

PERCENTAGE  OF  SALTS  IN  COW'S  MILK  IN  100  PARTS  OF  ASH 


Bunge 

(49) 

Abder- 

halden 

(50) 

Schloss 
(50) 

Soldner 

(51) 

Pelka 
(49) 

Richmond 

(52) 

K20 

22.14 
13.91 
20.05 
2.63 
0.04 
24.75 
21.27 

22.40 

12.25 

21.07 

2.91 

24.16 
17.25 

24.74 

10.79 

21.35 

2.71 

29.54 
13.63 

24.96 
6.16 

22.25 
2.71 

32.27 
10.86 

23.75 
15.36 
20.37 

27.13 
14.67 

28.71 

NajO 

6.67 

CaO 

20.27 

MgO 

2.80 

FeaOa 

.40 

P2O5 

29.33 

(CD 

14.00 

One  Liter  of  cow's 

milk  contains  in  grams: 

Soldner  (51) 

Schloss  (50) 

K2O 

1.72-1.885 

0.51-0.465 

1.98-1.72 

0.20-0.205 

1.82-2.437 

0.98-0.82 

1.849 

NajO 

0.861 

CaO 

1.650 

MgO 

0.215 

PaOs 

2.183 

CL 

1.091 

100  grams  of  the  Ash  of  Cream  contains  in  grams  (53) : 


K2O.  . 

Na20. 

CaO.. 

MgO.. 

P2O5. 

CL.  . 


25.97 
9.86 

20.54 
4.20 

30.23 

16.15 


ARTIFICIAL    FEEDING    OF    INFANTS  497 

It  would  be  trifling  for  me  to  point  out  the  value  of  mineral  salts  to 
the  infant  body;  they  are  very  essential  for  the  proper  balance,  growth 
and  functional  activity  of  all  its  cellular  elements.  They  enter  very 
largely  in  the  construction  of  the  bony  framework  of  the  infant's  growing 
body,  and  for  symmetrical  development  larger  quantities  are  required. 
They  also  maintain  normal  irritability  of  nerve  and  muscle  elements;  a 
lack  of  calcium  or  phosphorus  in  the  growing  infant  will  produce  abnor- 
malities in  the  bony  framework  and  will  greatly  exaggerate  the  irritabil- 
ity of  nerve  and  muscle. 

The  mineral  salts  and  their  combinations  are  a  very  essential  part  of 
the  infant's  food.  They  must  be  present  in  proper  relative  proportion, 
but  also  in  such  a  form  that  they  can  be  easily  absorbed  and  ai)propriated. 
This  absorption  of  mineral  salts  so  essential  to  the  proper  growth  of  the 
young  infant  can  only  be  accomplished  during  the  first  few  mouths  of  life 
by  the  administration  of  milk  as  a  medium  which  holds  the  nicely 
adjusted  balance.  Human  milk  is  the  ideal  food  for  this  purpose,  and 
next  to  that  is  some  adaptation  of  cow's  milk  to  meet  the  same  require- 
ments. Water  is  an  important  constituent  of  the  food  of  an  infant. 
About  68  per  cent  of  the  infant's  body  is  composed  of  water,  and  about 
87  per  cent  of  its  natural  food — milk — is  water. 

This  indicates  the  great  importance  water  has  in  the  physiological  pro- 
cess necessary  to  maintain  the  health  and  life  of  the  infant.  An  infant 
requires  four  or  five  times  as  much  water  in  proportion  to  body  weight  as 
an  adult.  Water  is  the  great  solvent  which  brings  into  solution  the  food 
of  the  infant  so  as  to  present  that  food  in  such  a  form  that  it  can  be  read- 
ily cared  for  by  the  digestive  organs.  It  carries  the  digested  food  through 
the  blood  and  lymph  channels  to  every  part  of  the  body.  This  common 
carrier  makes  up  about  78  per  cent  of  the  blood  and  96  per  cent  of  the 
lymph,  and  becomes  the  circulating  medium  of  the  body,  carrying  the 
important  elements  of  the  blood  and  lymph  to  every  cell  in  the  body  and 
carrying  away  from  the  cells,  to  be  excreted,  the  waste  materials  of  retro- 
grade tissue  metamorphosis.  This  excretion  of  body  waste  prevents  auto- 
intoxication and  is  effected  by  the  elimination  of  the  water  carrying  this 
waste  through  the  kidneys,  the  intestines,  the  skin,  and  the  lungs.  This 
elimination  is  much  more  active  during  infancy,  hence  the  supply  must 
be  constantly  renewed. 

DIASTATIC  FERMENT.— It  is  believed  by  many  physiologists  that  there 
exists  a  diastatic  ferment  in  human  milk  which  transforms  starch  into 
maltose  and  dextrose.  It  has  been  demonstrated  by  a  number  of  observers 
that  it  can  be  developed  in  cow's  milk  and  goat's  milk  by  feeding  them  on 


498  EEQUIREMENTS    OF    INFANT    FEEDING 

germinating  barley.  This  would  indicate  that  this  ferment  serves  an 
important  physiological  purpose  in  the  human  infant,  which  is  met  in 
some  other  way  in  the  young  of  the  cow  and  the  goat.  The  purpose 
served  is  perhaps  to  supplement  the  feeble  digestive  power  for  starch  in 
the  young  human  infant,  and  as  the  starch  digestive  capacity  of  the  young 
of  the  cow  and  the  goat  is  greater,  it  is  not  necessary  to  provide  this  fer- 
ment in  their  milk. 

VITAMINES  IN  COW'S  MILK.— Long  before  we  read  of  Casimir 
Funk (54)  and  his  studies,  we  knew  that  whole  clean  milk  is  next  to  the 
mother's  breast  the  very  best  food  for  the  growing  infant.  We  knew  that 
the  child  is  better  nourished  and  happier  on  whole  clean  milk,  that  diges- 
tion is  easier  and  development  more  regular  than  when  the  child  receives 
boiled  or  sterilized  milk.  We  knew  whole  milk  is  milk  with  the  life  in 
it,  not  boiled  milk  with  the  life  boiled  out  of  it.  Funk  tells  us  that  vitam- 
ines  or  certain  vital  "accessory  substances"  exist  in  whole  milk  that  serve 
to  prjtect  the  child  from  deficiency  diseases,  such  as  beriberi,  scorbutus, 
pellagra,  and  rickets.  He  thinks  these  diseases  are  due  to  the  absence  of 
certain  vital  substances  in  the  milk  which  he  calls  "vitamines."  He 
shows  in  his  article  that  milk  contains  a  considerable  number  of  these 
antiscorbutic  substances  as  well  as  substances  which  materially  favor  the 
growth  of  young  infants.  The  vitamines  are,  in  general,  very  sensitive  to 
heat.  Those  in  milk  are  relatively  stable.  They  are,  however,  partially 
destroyed  by  heating  milk  for  a  short  time,  and  totally  destroyed  by  long 
boiling  as  in  sterilization. 

The  development  of  scurvy  in  babies  taking  heated  milk  and  the 
greater  frequency  of  the  disease  when  the  food  is  boiled  or  sterilized  than 
when  it  is  pasteurized,  may  be  explained  by  assuming  that  the'  vitamines 
are  partially  or  wholly  destroyed  by  heat,  the  destruction  being  more  or 
less  complete  according  to  the  degree  and  duration  of  the  heating.  It  is 
true  scurvy  sometimes  develops  in  babies  taking  raw  milk  or  even  in 
babies  fed  at  the  breast.  This  explanation  of  the  development  of  scurvy 
on  a  diet  of  raw  milk  is  that  in  such  instances  the  milk  is  deficient  in 
vitamines. 

In  support  of  this  explanation  he  brings  forward  evidence  to  show 
that  the  amount  of  vitamines  in  the  milk  varies  with  the  amount  of  vitam- 
ines in  the  food  of  the  cows.  An  example  of  the  influence  of  the  food  of 
the  cows  upon  the  amount  of  vitamines  in  the  milk,  is  the  fact  that  their 
milk  contains  less  vitamines  in  the  winter,  when  they  are  eating  dry  food, 
than  in  the  summer,  when  they  are  eating  green  food.  The  development 
of  scurvy  in  infants  at  the  breast  may  be  explained  in  a  similar  way.   He 


ARTIFICIAL    FEEDING    OF    IxXFAKTS 


499 


calls  attention  to  the  fact,  moreover,  that  the  vitamines  are  diminished  in 
the  milk  of  women  who  are  underfed. 

Many  objections  can  be  raised  to  Funk's  arguments,  and  it  may  be 
urged  that  his  premises  are  incorrect  and  his  conclusions  consequently 
not  justified.  Still,  his  proposition  that  scurvy  is  caused  by  the  diminu- 
tion or  absence  of  certain  essential  vital  elements,  or  vitamines  in  the  food, 
reconciles  and  explains  the  clinical  facts  and  experimental  evidence  as  to 
the  etiology  of  this  disease  better  than  any  other  which  has  been  advanced. 

Condensed  Milk — This  type  of  milk  is  frequently  used  as  food  for 
young  children  during  an  emergency,  as  in  traveling  or  before  the  breast 
milk  lias  been  fully  established.  It  is  prepared  by  evaporating  cow's 
milk  about  one-fourth  in  volume  and  adding  cane  sugar  as  a  preservative ; 
this  is  added — five  to  six  ounces  of  sugar  to  the  pint.  The  composition  of 
condensed  milk  is  shown  by  Holt  in  the  following  table: 

TABLE  SHOWING  COMPOSITION  OF  CONDENSED  MILK 


Con- 
densed 
MUki 

With 

6  parts  of 

Water 

Added 

With 

12  parts  of 

Water 

With 

18  parts  of 

Water 

Fat 

per  cent 
6.94 
8.43 

50.69 

1.39 
31.30 

per  cent 
0.99 
1.20 

7.23 

0.17 
90.49 

per  cent 
0.53 
0.65 

3.90 

0.10 

94.82 

per  cent 
0.36 

Proteins 

0.44 

o               fCane,  40.44  \ 

2.67 

c»uj,ai  . .  .  |]viiik^    10.25  J 

Salts 

0.07 

Water 

96.46 

1  Analysis  of  Borden's  Eagle  Brand  of  Condensed  Milk  made  by  E.  E.  Smith,  Ph.D., 
M.D.  c 

An  examination  of  the  percentages  given  in  this  table  shows  that  con- 
densed milk  is  not  a  proper  food  for  young  or  older  infants,  inasmuch  as 
it  does  not  contain  the  proper  balance  of  food  contents,  fats,  protein  and 
sugar.  It  is  deficient  in  fats  and  proteins  and  too  rich  in  sugar.  Infants 
fed  on  condensed  milk  must  sooner  or  later  suffer  from  some  form  of 
nutritional  disturbance.  Condensed  milk  is  a  very  dangerous  food  if 
long  continued,  as  it  is  prone  to  give  parents  a  false  sense  of  security ;  it 
makes  fat  babies,  but  they  are  flabby  and  anemic.  Infants  fed  on  con- 
densed milk  have  weak  powers  of  resistance,  they  are  likely  to  chill  easily, 
suffer  from  bronchitis,  and  drift  into  rickets.  We  consider  the  early 
and  prolonged  use  of  condensed  milk  as  the  most  pi:olific  means  of  adenoid 


500  KEQUIKEMEKTS    OF    INFANT    FEEDING 

formation  by  devitalizing  the  mucous  membrane  of  the  nasopharynx.  As 
a  proof  of  this,  the  teeth  are  generally  defective  and  erupt  late  and  slowly, 
the  bony  skeleton  is  more  slowly  and  generally  imperfectly  developed. 
Although  condensed  milk  long  continued  almost  invariably  produces  more 
or  less  serious  malnutrition  in  some  form,  it  is  a  very  valuable  temporary 
food  for  infants  under  certain  conditions.  Its  advantages  are  quickly 
recognized  by  the  poor  mother  in  crowded  hot  cities.  It  is  cheap,  easily 
digested,  sterile,  easily .  prepared,  and  easily  manipulated.  It  appeals, 
therefore,  to  the  poor  who  cannot  afford  to  buy  clean  cow's  milk. 

Thousands  of  infants  in  our  larger  cities  are  carried  through  the 
summer  months  on  condensed  milk,  who  would  have  died  from  some  gas- 
tro-enteric  trouble  if  their  mothers  had  been  compelled  to  feed  them  upon 
such  cow's  milk  as  they  could  procure,  and  these  rachitic  malnourished 
infants,  who  have  passed  through  the  crisis  of  their  existence  on  condensed 
milk,  may  with  the  approach  of  the  cooler  weather,  gradually  overcome 
this  malnutrition  by  the  addition  of  more  wholesome  food  to  their  diet. 
The  difficulty  of  changing  the  diet  of  an  infant  kept  on  condensed  milk  to 
properly  adapted  cow's  milk  is  found  in  the  fact  that  the  infant's  digestive 
tube  has  not  been  properly  unfolded,  or  more  properly  speaking,  devel- 
oped, and  the  substitution  of  cow's  milk  involves  the  danger  of  adding 
gastro-intestinal  injury  to  malnutrition.  Great  care  is  necessary  on  the 
physician's  part  in  adding  very  gradually  the  correctly  adapted  cow's 
milk  to  the  condensed  milk  feedings. 

Buttermilk. — Buttermilk  has  been  used  as  an  infant  food  for  many 
years.  It  had  its  origin  in  Holland,  where  many  of  the  leading  physi- 
cians depend  on  it  and  obtain  remarkable  results.  It  deserves  more 
attention  in  America  than  it  has  received.  In  recent  years,  the  experience 
of  able  physicians  the  country  over  has  demonstrated  that  it  may  become 
a  valuable  substitute  for  cow's  milk  in  infants  suffering  from  various 
forms  of  gastro-intestinal  troubles.  The  buttermilk  used  in  infant  feed- 
ing is  usually  made  from  cream  or  milk  that  has  soured  naturally.  The 
souring  process  in  the  milk,  however,  may  be  started  by  inoculation  with 
sour  milk,  or  with  lactic  acid  bacilli  from  a  culture.  The  last  is  not  usual 
for  the  physician. 

Unfortunately,  the  composition  of  buttermilk  is  so  variable  that  results 
are  uncertain.  The  average,  however,  contains  about  one  per  cent  of  fat, 
four  per  cent  sugar,  and  three  per  cent  of  proteins.  It,  therefore,  should 
have  a  food  value  of  about  400  calories  to  the  quart.  Physicians  differ 
somewhat  in  their  methods  in  its  preparation  for  infant  feeding.  It  is 
usually  prepared  as  follows:  to  one  quart  of  buttermilk  are  added  two 


ARTIFICIAL    FEEDING    OF    INFANTS  501 

level  tablespoonfuls  of  wheat  flour  and  one  level  tablespoonful  of  cane 
sugar.  This  mixture  is,  with  constant  vigorous  stirring,  slowly  brought 
to  the  boiling  point  and  kept  there  for  twenty  minutes,  and  then  allowed 
to  cool.     The  constant  stirring  prevents  the  coagulation  of  casein. 

Buttermilk  prepared  in  this  way  has  the  same  percentage  of  fat  and 
protein  as  above  given,  but  the  carbohydrates  have  been  increased  to  ten 
per  cent,  and  the  food  value  of  the  mixture  has  been  increased  to  600 
calories  per  quart.  This  buttermilk  mixture,  when  considered  from  the 
standpoint  of  infants,  contains  a  low  percentage  of  fats  and  a  compara- 
tively high  percentage  of  proteins  and  a  very  high  percentage  of  carbo- 
hydrates. The  casein  is  very  finely  divided,  separated  from  its  calcium 
base,  and  appears  in  the  form  of  the  lactate  of  casein  which  cannot  be 
acted  upon  by  rennet,  but  which  is  readily  digested  by  the  intestinal  fer- 
ments.    The  acidity  varies  in  the  neighborhood  of  0.5  per  cent. 

The  chief  value  of  buttennilk,  therefore,  is  the  larger  quantity  of 
easily  digested  casein  which  it  contains,  the  small  amount  of  fat,  and  the 
large  quantity  of  easily  digested  carbohydrates,  which  substitute  the  fat 
in  serving  the  nutritional  demands  of  the  body. 

Buttermilk,  notwithstanding  the  fact  that  it  may  be  used  in  the  feed- 
ing of  well  infants  for  some  months  at  a  time  without  apparently  produc- 
ing nutritional  disturbances,  is  an  ill-balanced  food  mixture,  not  capable 
of  satisfying  the  full  nutritional  demands  of  the  rapidly  growing  infanti 
It  can  only  be  used,  therefore,  as  a  food  for  normal  infants  when  properly 
modified  cow's  milk  cannot  be  obtained. 

The  ideal  field  of  usefulness  for  buttermilk  is  found  in  that  class  of 
infants  deprived  of  the  maternal  breast  in  whom  the  improper  adapta- 
tion of  cow's  milk  has  produced  some  form  of  food  injury,  a  gastro-intes- 
tinal  disturbance,  and  who  are,  therefore,  temporarily,  unable  to  digest 
cow's  milk.  I  have  used  it  in  beginning  atrophy  and  acute  gastro- 
intestinal indigestion.  It  goes  without  saying  that  this  buttermilk 
formula  may  be  so  modified  by  the  addition  of  sterile  water  as  to  suit  the 
age  and  digestive  capacity  of  the  infant. 

Peptonized  Milk. — In  the  artificial  feeding  of  premature  or  malnour- 
ished infants,  the  milk  used  (cow's  milk)  may  be  partially  or  wholly 
peptonized.  In  the  management  of  this  class  of  infants  there  frequently 
arises  a  period  where  wholly  peptonized  milk  is  necessary.  This  period, 
however,  must  not  be  prolonged  or  we  fail  in  developing  the  infant's 
digestive  capacity.  The  moment  we  find  the  infant  is  gaining  daily  it 
is  our  duty  to  lessen  the  length  of  time  the  milk  is  peptonized.  With  this 
fact  firmly  in  our  minds,  we  may  use  with  great  advantage  partially  or 

132 


502  KEQUIREMENTS    OF    INFA:N^T    FEEDING 

wholly  peptonized  milk  in  feeble  or  immature  infants  until  we  gain  con- 
trol of  the  digestive  tube,  for  by  so  doing  we  not  only  save  the  child  from 
atrophy,  but  we  may  also  prevent  its  drifting  into  rickets.  The  rule, 
therefore,  in  using  a  peptonized  milk  formula  is  to  administer  it  until 
the  infant's  stomach  has  regained  sufficient  power  to  assimilate  the  proper 
cow's  milk  adaptation.  The  infant's  stomach  not  only  requires  proper 
food,  but  it  also  requires  the  chance  to  digest  milk,  which  is  its  proper 
function.  If  we  fail  to  unfold  the  digestive  function  by  withholding 
proper  food,  we  seriously  handicap  the  infant's  progress.  Peptonizing 
tubes  are  on  the  market  rendering  the  procedure  very  convenient  for  the 
physician  and  the  mother,  one  tube  containing  enough  for  a  pint  of  milk 
— usually  associated  with  a  little  bicarbonate  of  soda  to  prevent 
coagulation. 

The  milk  is  peptonized  at  a  temperature  of  110°F.  for  ten  to  fifteen 
minutes,  when  it  is  immediately  placed  on  ice  to  arrest  the  further  pep- 
tonization. Care  must  be  exercised  not  to  push  the  process  too  far  or  the 
milk  will  acquire  a  bitter  taste  and  the  child  will  refuse  to  take  it.  Cane 
sugar  can  be  added  if  necessary  to  overcome  the  bitter  taste.  I  have 
found  in  my  work  that  keeping  the  milk  at  a  tem])erature  of  110° F.  for 
six  to  ten  minutes  is  usually  sufficient.  This  is  a  decided  advantage  for 
the  infant  in  many  ways  and  is  much  better  when  we  commence  to  with- 
draw the  peptonized  milk. 

Sterilized  Milk — Sterilized  milk  is  still  used  by  a  very  large  propor- 
tion of  the  city's  poor.  With  all  the  combined  efforts  of  health  boards 
and  medical  societies  it  has  been  found  impossible  to  furnish  clean  whole 
milk  at  a  price  within  the  reach  of  the  poor.  The  "certified"  and 
"inspected"  milk,  owing  to  its  prohibitive  price,  can  be  utilized  in  the 
feeding  of  only  a  comparatively  small  percentage  of  the  infant  popula- 
tion of  our  larger  cities.  For  this  reason,  sterilization  and  pasteurization 
of  milk  still  remain  most  important  life-saving  measures  in  the  feeding 
of  infants  during  the  summer  months;  it  is  the  only  reasonable  method, 
when,  by  reason  of  the  heat,  milk  contamination  increases  rapidly.  It  is 
well  for  us  to  remember  that  we  cannot  sterilize  unclean  milk,  milk  con- 
taining large  numbers  of  micro-organisms,  without  impairment  of  its 
nutritive  value.  Milk  which  has  undergone  fermentative  changes  and 
which  may  produce  poisonous  irritating  bodies,  is  a  dangerous  food  for 
infants.  Milk  thus  exposed  and  contaminated  cannot  be  made  wholesome 
by  sterilization.  If  we  wish  to  sterilize  as  a  means  of  preventing  bacterial 
contamination,  it  is  necessary  to  start  with  the  cleanest  milk  that  is 
obtainable. 


ARTIFICIAL    FEEDING    OF    INFANTS  503 

Cow's  milk  is  sterilized  by  heating  to  212°  F.  for  twenty  minutes. 
This  is  what  is  usually  known  as  sterilized  milk ;  the  heat  destroys  the 
vitamines  and  all  the  developed  bacteria,  but  does  not  destroy  the  spores ; 
tlius  the  milk  is  not  actually  sterile,  for  the  spores  after  a  time  develop 
into  bacteria.  The  sporulated  bacteria  are  not  of  sufficient  importance 
to  justify  the  additional  application  of  heat.  Sterilization  of  milk  is  best 
accomplished  by  placing  the  milk  bottles  in  boiling  water  for  twenty  min- 
utes, boiling  hard  and  filling  the  tops  with  sterile  cotton  and  then  placing 
on  ice  for  use.  The  Arnold  Stearns  Sterilizer  is  a  convenience  and  of 
great  practical  value  for  the  poor  of  large  cities.  It  is  cheap  and  its 
simplicity  is  apparent  to  all. 

ADVANTAGES  OF  STERILIZED  MILK.- The  advantages  derived  from 
sterilized  milk  must  be  mentioned.  There  is  a  loss  of  acidity  on  the 
part  of  the  milk  which  causes  a  retardation  in  the  rennin  coagulation  and 
thereby  causes  the  casein  to  be  precipitated  in  finer  flakes,  so  that  it  is 
more  readily  acted  upon  by  digestive  ferments ;  large  casein  curds  never 
form  in  sterilized  milk.  The  fermentative  processes  are  stopped  and  the 
milk  is  not  further  contaminated  by  bacteria.  This  is  the  important 
object  of  the  work  and  greatly  reduces  the  dangers  of  milk  poisoning. 
Sterilization  is  a  cheap  method  of  preserving  milk  and  is  practically  the 
only  way  for  the  poor  to  keep  milk  wholesome  for  their  children.  The 
poor  can  neither  keep  nor  handle  clean  raw  milk;  they  cannot  afford  to 
do  so,  even  if  they  knew  how.  Sterilized  milk  is  better  than  the  patent 
foods  or  condensed  milk  for  the  very  poor.  If  the  infant  is  capable  of 
digesting  sterilized  milk,  this  serves  nutritional  purposes  much  better 
than  the  proprietary  foods. 

DISADVANTAGES  OF  STERILIZED  MILK.— The  disadvantages  of  steri- 
lized milk,  unfortunately,  are  many.  The  decomposition  of  nuclein,  a  sep- 
aration of  the  phosphorus  from  its  organic  union ;  partial  destruction  of 
the  fat  emulsion;  increased  difficulty  in  the  digestion  of  casein;  partial 
separation  of  tlie  lime  salts  from  the  combination  with  calcium,  which 
renders  them  less  easily  absorbed ;  complete  destruction  of  ferments, 
alexins,  agglutinins  and  other  vital  principles  in  the  milk.  The  loss  of 
vital  principle  (vitamines)  is  the  most  important.  The  radical  change 
in  the  milk,  converting  a  living  vital  element  into  a  dead  product  means 
a  great  nutritional  loss  to  the  infant.  Sterilized  milk  being  hard  to 
digest  constipates  the  infant,  who  as  a  result  frequently  faces  intestinal 
intoxication  with  all  its  constitutional  depreciation. 

Pasteurized  Milk — Physicians  actively  engaged  in  infant  feeding  soon 
realized  the  defects  of  sterilized  milk  and  began  to  try  milk  treated  at  a 


504  REQUIREMENTS    OF    INFANT    FEEDING 

lower  temperature.  This  was  done  with  the  hope  of  destroying  the 
bacteria  without  producing  important  chemical  and  biological  changes  in 
the  milk.  Koplik  first  suggested  heating  the  milk  and  Monti  recom- 
mended a  temperature  of  180°F. ;  Freeman  has  insisted  on  a  still  lower 
temj^erature  and  his  apparatus  has  done  much  to  popularize  the  method. 
This  process  aims  at  killing  the  greater  part  of  the  developed  bacteria 
without  producing  serious  chemical  or  biological  changes  in  the  milk. 
The  procedure  is  called  pasteurization  to  distinguish  it  from  sterilization. 
Pasteurized  milk  is  very  generally  used  in  this  country,  especially  in  our 
larger  cities  during  the  summer  months,  and  when  properly  used  becomes 
a  most  important  means  of  saving  young  infants. 

Freeman's  conclusions  on  the  subject  are  as  follows:  "Milk  for  infant' 
feeding  should  be  pasteurized  so  as  not  to  interfere  with  its  biological 
properties  or  chemical  composition,  but  at  a  sufficient  temperature  to 
destroy  the  bulk  of  the  bacteria  present,  including  the  tubercle  bacilli. 
A  temperature  of  140°F.  continued  for  forty  minutes  would  seem  to  fulfil 
these  indications."  Freeman  also  says  the  question  concerning  the  effect 
of  heat  on  ferments  has  been  carefully  worked  out  by  Hippins.  The  salol- 
splitting  ferment  found  only  in  mother's  milk  was  weakened  by  a  tem- 
perature of  131°F.  and  destroyed  at  149°F.,  while  the  amylolytic  fer- 
ment found  only  in  mother's  milk  was  weakened  by  a  temperature  of 
158°F.  and  destroyed  at  167°F. 

It  seems  evident,  therefore,  that  the  careful  pasteurization  of  mill^ 
may  serve  the  purpose  of  checking  the  fermentation  process  without 
materially  changing  its  chemical  composition  or  biological  properties. 
Clinical  experience  strengthens  this  opinion,  for  milk  pasteurized  at  low 
temperature  may  be  fed  for  a  long  time  with  practically  the  same  results 
as  are  obtained  from  fresh  clean  raw  milk.  The  preparation  of  pasteur- 
ized milk,  however,  requires  time,  care  and  intelligence ;  moreover,  a  sub- 
sequent refrigerator  temperature  is  necessary  in  order  to  prevent  bacterial 
contamination.  The  method  is,  therefore,  not  commonly  available  for  use 
among  the  poor  of  our  large  cities.  It  has,  however,  a  large  field  of"  use- 
fulness among  those  city  dwellers  who  have  the  time  and  intelligence  to 
prepare  pasteurized  milk  and  the  facilities  to  care  for  it  after  its  prepar- 
ation, as  in  our  large  cities  even  the  best  available  milk  is  rendered  safer 
during  the  hot  summer  months  by  pasteurization. 

Proprietary  or  Patent  Foods. — The  market  is  full  of  convenient  foods 
to  feed  the  baby  when  the  maternal  breast  fails  to  furnish  the  natural 
supply.  These  foods  are  attractively  placed  before  the  public  and  are 
convenient  to  use,  hence  young  mothers  are  readily  induced  to  resort  to 


ARTIFICIAL    FEEDING    OF    IJs^FANTS  505 

them  without  proper  regard  to  their  real  value.  All  these  foods  possess 
some  nutritive  properties,  and  may  prove  useful  in  an  emergency.  It  is 
well,  however,  to  remember  that  infant  foods,  to  be  of  any  value,  must 
possess  fats,  sugar  and  protein  in  certain  definite  proportions,  associated 
with  mineral  matters.  Any  proprietary  food  that  does  not  contain  flie 
above  elements  in  proper  proportions  can  do  but  little  good.  The  elements 
of  infant  food  are  easily  procured  and  can  be  obtained  in  modified  milk. 
We  do  not  understand  why  so  many  young  mothers  under  the  close  obser- 
vance of  their  physician  are  allowed  to  resort  to  many  of  the  proprietary 
foods.  Inasmuch  as  they  all  possess  some  value  while  lacking  some  of  the 
essential  elements,  it  is  not  desirable  to  encourage  their  use,  unless  it  is 
to  bridge  over  a  passing  difficulty.  A  very  brief  outline  of  a  few  of  these 
foods  seems  desirable. 

NESTLE'S  FOOD.— !Restle's  Food  is  one  of  the  most  convenient  and 
easily  digested  of  the  proprietary  foods.  It  is  found  to  be  a  convenient 
and  valuable  substitute  for  cow's  milk  in  infants  suffering  from  gastro- 
intestinal troubles,  especially  during  the  hot  weather,  yet  if  long  contin- 
ued, it  is  disastrous  in  its  results.  Its  indefinite  employment  will  most 
certainly  produce  rickets  or  scorbutus.  Chittenden's  analysis  of  Nestle's 
Food  prepared  for  infants  of  six  months,  shows  that  this  food  prepared  for 
this  age  contains  only  0.81  per  cent  of  albuminoids  and  0.36  per  cent  fat. 
This  marked  deficiency  in  fat  and  protein  renders  it  quite  unfit  to  serve 
the  nutritional  demands  of  the  infant  for  any  length  of  time. 

When  it  is  found  necessary  to  use  Nestle's  Food  it  should  only  be 
allowed  until  acute  symptoms  have  been  controlled,  after  which  small 
(juantities  of  cow's  milk  shoidd  be  added,  and  as  the  child  continues  to 
convalesce,  additions  of  milk  should  1x3  gradually  made  and  Nestle's  Food 
mixture  likewise  diminished,  until  a  modified  milk  formula  replaces  the 
proprietary  food.  If,  however,  it  be  found  necessary  for  some  time  to 
continue  Nestle's  Food,  or  any  other  patent  food,  by  reason  of  digestive 
weakness,  the  infant  should  be  given  supplemental  foods  in  form  of 
orange  juice,  pineapple  juice,  or  that  which  is  more  valuable,  beef  juice. 
This  addition  to  a  weak  infant's  diet  very  frequently  prevents  scorbutus 
or  rickets  which  frequently  follow  in  the  wake  of  ill-balanced  feeding. 

MALTED  MILK.— Malted  milk  is  a  proprietary  milk  food  which,  like 
condensed  milk  and  all  the  proprietary  foods,  is  very  poor  in  fat  and 
protein.  It  is  unsuitable  as  an  exclusive  food  for  infants.  It  is  safe, 
however,  for  a  brief  period  as  a  substitute  for  milk  in  traveling  or  when, 
for  any  other  reason,  cow's  milk  is  not  obtainable.  It  is,  like  condensed 
milk,  very  extensively  used  among  the  poor  of  our  cities,  because  it  is 


506  REQUIKEMENTS    OF    INFANT    FEEDING 

easily  digested,  easily  i)repared,   and  serves  the  purpose  of  tiding  the 
infant  over  the  hot  summer  months. 

Home  Modifications  or  Adaptation  of  Milk — This  is  seemingly  a  most 
difficult  topic  to  adjust  in  many  physicians'  minds,  and  the  study  of  the 
subject  must  be  based  upon  the  elements  of  nutrition  themselves.  A  few 
essentials  from  Cheadle,  written  nearly  thirty  years  ago,  may  be  of  value 
in  crystallizing  in  our  minds  the  principles  of  cow's  milk  feeding  as  out- 
lined in  the  preceding  pages. 

(a)  The  food  must  contain  the  different  elements  in  about  the  same 
proportions  as  found  in  human  niilh,  viz.,  proteins,  one  to  two  per  cent ; 
fats,  three  to  four  per  cent;  carbohydrates,  six  to  seven  per  cent;  salts, 
two-tenths  per  cent ;  water,  eighty-eight  per  cent.  This  represents  theoret- 
ically the  ideal  food  for  a  balanced  nutrition.  The  chemist  can  readily 
produce  a  mixture  which  duplicates  breast  milk  in  the  nutritive  value 
of  its  constituents  and  even  resembles  somewhat  closely  that  emulsion  in 
its  physical  appearance,  but  the  dismal  array  of  failures  to  reproduce 
mother's  milk  by  a  synthetic  arrangement  of  apparently  similar  constitu- 
ents obtained  from  other  sources,  is  an  emphatic  reminder  of  the  limita- 
tions of  both  chemical  and  physiological  knowledge. 

(b)  It  should  not  he  purely  vegetable,  hut  must  contain  a  large  pro- 
portion of  animal  matter.  Most  vegetable  substances  are  deficient  in 
available  proteins  and  yield  but  a  small  quantity  of  fat.  Moreover,  it  is 
known  that  the  infant  does  not  assimilate  them  as  easily  and  fully  as 
those  derived  from  animal  sources,  even  though  these  ingredients  be  sup- 
plied in  the  proper  percentage. 

(c)  It  must  he  in  a  form  suitable  to  infantile  digestion.  The  digest- 
ive organs  have  only  recently  assumed  their  function,  and  are  designed  to 
deal  solely  with  the  bland,  dilute,  and  easily  dissolved  nutriment  of 
mother's  milk.  In  the  natural  method  of  feeding  the  infant  gets  Bis 
nourishment  in  the  same  form  at  every  meal ;  so  in  artificial  feeding, 
variety  is  not  desirable.  It  is  presumed  that  infants  under  six  months 
are  unable  to  digest  much  starch  from  the  paucity  of  ptyalin  and  amy- 
lopsin ;  hence,  for  this  age  any  great  amount  of  starch  in  a  food  is  enough 
to  condemn  it.  As  the  walls  of  the  stomach  are  lacking  in  muscular  power 
and  the  secretions  are  feeble,  it  is  evident  that  this  organ  is  unable  to 
deal  with  large  massee  of  solid  matter.  Solids  can  be  digested  only  in  a 
state  of  minute  subdivision. 

(d)  The  total  c/uantity  in  twenty-four  hours  must  represent  the  equiv- 
alent, in  nutritive  value,  of  from  one  to  three  pints  of  human  milk, 
according  to  the  infant's  age.    No  fixed  rule  can  be  given  for  all  children. 


AETIFICIAL    FEEDING    OF    INFANTS  507 

Careful  observation  of  the  infant  as  to  whether  he  rejects  some  of  his 
food  soon  after  ingestion,  or  seems  hungry  half  an  hour  after  feeding, 
may  serve  as  a  guide.  The  best  indication  that  he  is  receiving  his  full' 
equivalent  is  a  steady  weekly  gain  of  from  two  to  five  ounces — or  more 
in  the  early  months. 

(e)  It  must  possess  the  antiscorbutic  property.  It  is  not  yet  known 
in  what  this  consists,  but  it  is  known  that  infants  at  the  breast  very  rarely 
suffer  from  scurvy,  and  that  the  disease  is  found  among  those  fed  upon 
condensed  or  sterilized  milk,  or  upon  desiccated  milk  preparations. 
Prompt  recovery,  with  food  unchanged  (except  the  discontinuance  of 
sterilization),  has  been  reported  by  several  observers.  Fresh  milk,  there- 
fore, possesses,  in  addition  to  the  important  principles,  this  antiscorbutic 
element  (vitamines),  but  not  in  large  proportion,  for  milk  in  extreme 
dilution  will  not  prevent  the  development  of  this  disease. 

(f )  It  must  he  fresh,  clean  and  free  from  excessive  bacterial  content. 
It  is  true  that  hydrochloric  acid  has  antiseptic  properties,  but  the  stom- 
ach secretes  only  a  limited  quantity  of  it  during  the  first  half  year. 
Hence,  infants  are  extremely  susceptible  to  gastro-enteric  disorders,  hav- 
ing little  resistance  to  bacterial  invasion.  The  deadly  toxins  which 
develop  in  old  milk  may  resist  all  efforts  at  sterilization. 

(g)  Another  essential^  voiced  by  Chapin,  may  well  he  added,  viz.,  in 
feeding  young  animals  it  is  not  only  necessary  to  supply  the  proper  quan- 
tities of  nutritional  elements,  but  they  must  be  in  such  form  as  normally 
to  develop  the  digestive  tract. 

This  writer  calls  attention  to  the  physical  and  chemical  differences  in 
the  milk  of  various  mammals,  and  shows  that  each  is  especially  adapted 
not  only  to  the  nutrition  but  to  the  digestive  development  of  its  particular 
young — as,  for  instance,  the  bovine  calf,  which,  doubling  its  birth  weight 
in  forty-seven  days,  attains  pubescence  in  one  year  with  a  ruminant 
digestive  tract  twenty  times  the  body  length  that  must  be  fitted  quickly 
to  obtain  food  elements  from  coarse  herbage.  The  calf  needs  a  dense, 
quickly  curdling,  rich  protein  milk  for  early  development  of  both  muscular 
and  secretory  functions  in  his  stomach,  which  constitutes  seventy  per  cent 
of  the  digestive  tract.  The  human  infant,  on  the  other  hand,  who  doubles 
weight  in  one  hundred  and  sixty  days  and  attains  puberty  in  fourteen 
years,  finds  only  in  his  mother's  milk  the  ingredients  suitable  for  the  de- 
velopment of  the  digestive  tract,  which  is  only  six  times  his  body  length, 
and  of  which  only  twenty  per  cent  is  stomach.  Hence,  the  early  feeble 
gastric  digestion  must  be  slowly  cultivated  by  gradually  increasing  density 
of  the  flocculent  curds  characteristic  of  human  milk  alone. 


508  REQUIREMENTS    OF    INFANT    FEEDING 

PROPRIETARY   FOOD   PERCENTAGES 


Pebcentages 

Name  of  Food 

Fat 

Sugar 

Pro- 
tein 

Starch 

Ash 

SouncE  OP  Analysis 

Condensed  Milk,  Eagle  Brand 
Condensed  Milk,  St.  Charles . 

9.61 
8.70 

16.50 

12.12 
8.78 

0.16 
17.00 
18.60 

15.88 

1.05 
3.52 

5.50 

0.26 
0.92 

1.04 
1.00 

54.94 
10.95 

34.65 

55.34 
67.95 

79.57 

93.00 
55.00 

66.55 

70.90 

25.11 
55.82 

58.93 

7.80 
3.34 

1.80 

Cane 42.91 

Milk 12.03 

Milk 

8.01 
8.80 

7.00 

16.35 
10.35 

18.00 
10.66 

9.90 
10.23 

6.70 

14.34 

12.50 

12.12 
14.00 

11.40 

60.01 

29.90 

15.39 

73.67 

77.02 
73.54 

75.105 

1.78 
1.40 

1.50 
4.93 
3.86 
4.30 

2.00 
4.00 

3.95 

3.71 
0.60 

0.99 

2.03 

0.61 

0.97 
0.39 

0.50 

Own  advertisement 
Jordon    &    Mott,    Am: 

Cane 20.91 

Milk 13.74 

Milk 24.35 

Milk 49.15 

Malt     

Jour.  Public  Hygiene, 
1910,  XX,  391 
Own  advertisement 

Mellin's  Food  Co. 

Horlick's  Malted  Milk 

Own  advertisement 

Mellin's  Food 

Dextrose.... 18.80 

Malt 58.88 

Dextrins..  .20.69 

Malt 52.00 

Dextrins..  .41.00 

Milk 25.00 

Malt 25.00 

Dextrins...    5.00 

Milk 42.00 

Malt 14.00 

Dextrins...  10.00 

Milk 36.00 

Malt 20.00 

Dextrins....  13.00 

Malt 16.50 

Dextrins. .  .   8.50 

Milk 54.12 

Dextrins. .  .    1.70 

Milk 6.57 

Cane 25.00 

Malt 

Own  advertisement 

Mead's  Dextri-Maltose: 
No.  1 

Own  advertisement  * 

Allenbury's  Foods: 

No.  1  Milk 

Own  analysis 

No.  2  Milk 

cept     proportions    of 
sugars.     These   given 
approximately  from 
analyses    made    by 
Mellin's  Food  Co. 

No.  3  Malted 

Eskay's  Albuminized  Food. . . 

Own  analysis 
Own  advertisement 

Ridge's  Food 

Dextrins..  .27.36 
Milk 

Benger's  Food 

Largely   dextrins 

and  sugars. . . . 

Dextrose...   0.42 

Dextrins 1.38 

Own  analysis  ' 

Holt,  Diseases    of  *    In- 

Wheat Flour 

fancy  and  Childhood, 
1911,  p.  162 
Bulletin   No.   28,   U.  S. 

Dept.  of  Agric. 

1  Proprietors  state  that  this  analysis  is  only  approximate,  that  the  percentages  of 
maltose  and  dextrin  vary  from  1  per  cent  to  2  per  cent  and  that  many  samples  show 
traces  of  protein  and  fat.  "No.  2"  is  the  same  as  "No.  1,"  except  that  it  does  not 
contain  the  2  per  cent  of  salt. 

2  Proprietors  wish  to  emphasize  the  fact  that  the  directions  call  for  boiling,  which 
"gelatinizes  the  starch  in  the  form  of  colloids." 

3  Proprietors  wish  to  call  attention  to  the  fact  that  the  food  contains  active  amy- 
lolytic  and  tryptic  ferments  which,  when  the  food  is  prepared  according  to  the  direc- 
tions, "convert  the  starch  into  subtle  sugars  and  modify  the  casein." 

4  Proprietors  wish  to  direct  attention  to  the  fact  that  Imperial  Granum  is  intended 
to  be  used  with  milk, 

5  Total  carbohydrates. 

It  has  been  stated  that  the  substitute  feeding  of  infants  is  a  broad 
subject.  If  the  breadth  of  this  subject  is  indicated  by  the  number  and 
apparent  variety  of  infant  foods  on  the  market,  a  student  may  well  quail 
before  it.  To  the  query  why  such  a  large  number  of  foods  and  prepara- 
tions, the  reply  has  been  made  that  commercial  enterprise  is  responsible 
for  this,  as  it  is  also  for  the  innumerable  foods  and  preparations  for  adult 


ARTIFICIAL  ■  FEEDING    OF    INFANTS  509 

use ;  also  that  manufacturing  ingenuity  is  stimulated  to  furnish  presumed 
nutriment  in  a  great  variety  of  forms  by  the  whims,  caprices,  and  tastes 
of  individual  appetites. 

A  list  of  proprietary  foods  (see  opposite  page)  is  briefly  outlined  as 
given  by  Morse  and  Talbot,  with  short  criticisms  of  a  few  of  the  more 
popular  brands. 

Man  is  an  animal  with  educated  or  perverted  tastes  which  result  in 
a  demand  for  variety  in  his  viands.  The  adult  is  capable,  also,  of  deter- 
mining, to  some  extent,  the  nutriment  derived  therefrom.  At  any  rate, 
he  may  recognize  some  of  the  more  immediate  effects  following  the  inges- 
tion of  different  foods.  The  infant,  on  the  other  hand,  is  but  slightly 
conscious  of  food  effects,  either  immediate  or  remote.  Rarely  in  early 
life  has  he  tastes,  either  acquired  or  perverted.  Instinctively  he  craves 
nourishment,  and  is  almost  invariably  satisfied  with  that  furnished  nor- 
mally by  the  breast.  Variety  in  form  or  flavor  is  neither  desired  nor 
desirable.  Reference  to  the  essentials  above  enumerated  will  show  that 
uniformity  of  food,  containing  the  five  constituents,  is  what  the  infant 
requires  and  with  which  he  is  satisfied.  The  great  variety  of  baby  foods 
on  the  market  is  partly  the  result  of  prejudice  and  ignorance. 

The  average  mother's  withdrawing  her  breast  from  the  infant  is 
likened  to  a  vessel  at  anchor  in  a  safe  roadbed,  slipping  the  cable  in  the 
absence  of  the  pilot,  chart  or  compass.  The  baby  knows  not  what  he 
needs,  the  mother  knows  little  more ;  but  she  can  read,  and  the  claims  of 
the  enterprising  food  agents  attract  her  attention.  Too  often  physicians, 
also,  derive  their  supposed  knowledge  of  infant  dietetics  from  the  same 
source. 

The  Clinical  Application  of  Artificial  Feedingf. — It  is  well  to  keep  in 
mind  the  six  rules  of  Dr.  Cotton  if  we  would  have  the  infant  develop 
])hysiologically. 

(a)  That  the  long-continued  use  of  food  deficient  in  fat  and,  lecithin  tends  to 
the  production  of  malnutrition  and  rickets. 

(&)  Deficiency  in  soluble  proteins  retards  all  development.  It  is  slow 
starvation. 

(c)  The  use  of  cooked  foods  may  result  in  scorbutus,  hence  even  sterilized 
milk  should  not  be  administered  continuously. 

(d)  Food  which  would  not  meet  the  requirements  of  nutrition  for  a  long- 
continued  period,  because  deficient  in  some  essential  constituent,  may  be  used 
temporarily,  as  in  traveling,  weaning,  or  temporary  removal  from  breast. 

(e)  Gastric  digestion  must  be  developed  by  some  substance  which  furnishes 
soft  coagula,  for  which  purpose  nothing  is  known  to  equal  milk. 

if)  It  is  not  sufficient  merely  to  correct  dyspepsia,  the  infant  must  be 
nourished  and  show  a  gain  in  weight  and  strength. 


510 


REQUIREMENTS    OF    INFANT    FEEDING 


With  the  essential  elements  of  cow's  milk  well  understood  and  not 
forgetting  Dr.  Cotton's  six  rules  for  artificial  feeding,  we  must  remember 
that  success  in  infant  feeding  depends,  not  upon  the  particular  method 
used,  but  upon  the  intelligence,  the  experience  and  the  knowledge  of  the 
working  principles  of  infant  feeding  which  the  physician  possesses. 
Every  infant  is  a  law  unto  itself,  and  the  essential  law  of  success  is  the 
discovery  of  the  infant's  strength  or  weakness  toward  some  one  of  the 
various  ingredients  of  the  milk.  Clean  milk  is,  of  course,  absolutely 
necessary  to  success  in  infant  feeding.  Infected  or  unclean  milk  cannot 
be  made  safe  for  feeding  even  if  it  is  pasteurized.  This  knowledge  is  of 
more  importance  than  the  method  of  feeding.  Cream  is  more  easily  con- 
taminated than  milk,  and  when  over  twenty-four  hours  old  unsafe  for 
infant  feeding.  If  it  is  found  necessary  to  increase  the  percentage  of 
fat  in  an  infant's  formula,  it  should  be  done  by  taking  it  off  the  top  of 
clean  milk.  Healthy  common  cows  are  safer  than  the  Alderney  or  Jersey, 
in  which  the  fat  percentage  is  too  high  and  the  fat  difficult  to  digest. 
Accordingly,  the  common  cow  is  best  for  infant  feeding. 

Overfeeding,  not  only  in  calories,  but  in  the  number  of  ounces,  is 
frequently  disastrous  to  the  child,  no  matter  what  formula  is  used.  It  is 
very  important  to  respect  the  child's  capacity;  if  we  do  not  bring  on 
digestive  disturbances  of  an  acute  nature,  we  will  eventually  induce  a 
dilatation  of  the  stomach  with  chronic  indigestion,  which  years  of  careful 
feeding  will  fail  to  overcome.  To  give  an  infant  all  he  will  take  is  a 
very  common  practice.  We  must  remember  the  gastric  capacity  of 
infancy  and  feed  accordingly.  I  have  never  given  over  eight  or  nine 
ounces  at  one  feeding  while  the  child  was  under  one  year.  If  we  give 
more,  we  should  increase  the  quality  and  not  the  quantity. 


PROPER  FEEDING  INTERVALS  FOR  INFANTS  OF  VARIOUS  AGES 
(MORSE  AND  TALBOT) 


Age 

24  hour  Amount 

Number  of  Feedings,  Amount  and 

Intervals 

1  week 
4  weeks 

10-12  oz. 
20 

J 10  feedings 

1   8 
J   8 
1  7        « 

of  1      oz.  at  2 

"  IK    "    "  2K 

«  2K    "    "  2K 
«  3        «    «  3 

tiour  intervals 

u              a 
tt                a 
a                a 

4  months 
6       « 

9       « 

32         " 
36-40   « 

48 

7 
6 

1  6 
I  5 

u 
u 

u 
li 

«4K    "    "3 
''6K    "    "3 
"8        "    "  3 
«  9K    "    "  3-4 

a 
u 
u 
u 

u 
a 
u 
u 

ARTIFICIAL   FEEDING   OF    INFANTS  511 

Artificially  fed  infants,  like  the  breast-fed,  should  be  given  their 
food  at  regular  intervals.  This  is  important  in  order  to  obtain  good 
results.  The  intervals  may  be  one,  two,  three,  four  or  five-hour  periods 
to  suit  digestive  capacity  as  well  as  age  and  weight  of  the  child.  Usually 
night  feeding  can  be  omitted  after  the  fourth  month.  The  feedings 
between  6  a.m.  and  10  p.m.  must  be  observed  with  the  strictest  regu- 
larity. When  the  child  is  about  eight  months  old  four  feedings  in  the 
twenty-four  hours  are  enough,  beginning  at  6  or  7  a.m.  and  finishing  at 
6  or  7  P.M. 

While  the  infant  is  taking  his  food,  he  should  be  quiet,  free  from  light 
and  excitement.  Food  given  while  the  child  is  surrounded  by  noise;  light, 
and  various  members  of  the  family,  creates  irritability  and  disturbs  diges-* 
tion,  laying  the  foundation  for  many  ills  later  in  life.  Infants  should  be 
taught  to  lie  quietly  and  their  surroundings  should  be  quiet  to  secure  pro- 
found sleep.  The  rapidly  growing  nervous  system  of  the  infant  is  easily 
excited  by  an  outside  factor,  exerting  an  unfavorable  influence  on  the 
digestive  organs. 

Good  air  is  as  important  to  the  infant  as  clean  milk,  and  as  early  as 
the  first  week  in  summer,  provided  the  weather  permits,  the  child  should 
sleep  out  of  doors  during  the  day.  During  winter  the  first  outings  should! 
consist  in  widely  opening  all  windows.  By  the  time  the  child  is  two 
months  old,  most  of  the  sleeping  during  favorable  weather  should  be  in 
the  open.  Undue  light  and  drafts  can  be  controlled  by  the  proper  adjust- 
ment of  couch,  carriage  or  hammock. 

The  infant's  food  should  contain  the  necessary  elements,  fat,  protein 
and  sugar,  in  reasonably  accurate  percentages  in  order  to  maintain  good 
health.  If  fever  occurs,  as  a  result  of  improper  food  or  feeding,  or  by 
reason  of  any  acute  infection,  then  the  withdrawal  of  the  milk-formula 
is  necessary.  As  .Tacobi  well  states,  "Milk  is  food  for  infants  when  well, 
but  food  for  bacteria  when  sick."  After  an  illness  has  subsided,  the 
gradual  return  of  the  whole  formula  is  necessary — not  omitting  protein 
and  fats,  as  so  many  do.  Barley  water,  orange  juice,  or  plain  water  will 
tide  an  infant  over  an  illness  lasting  one  week  or  more  before  milk  can 
be  resumed  with  safety. 

It  is  a  well-known  fact  that  the  fat  of  cow's  milk  is  not  easy  to  digest. 
It  is  necessary  to  remember  this  and  to  place  the  percentages  of  fat  in 
modified  milk-mixtures  for  young  infants  much  lower  than  found  in 
human  milk.  The  excess  of  fat  which  is  usually  used  too  freely,  is  one 
of  the  most  common  causes  of  indigestion  in  young  infants.  When  the 
child  is  restless,  colicky,  and  has  loose  stools,  the  first  correction  in  the 


512  KEQUIEEMENTS    OF    INFANT    FEEDING 

food  formula  to  be  made  in  the  trial  cliaiige  should  be  a  reduction  of  fat 
and  a  corresponding  increase  in  calories,  namely  sugar.  The  further 
indications  for  this  change  in  the  food  formula  are,  viz.,  (a)  if  the  infant 
regurgitates  its  food;  (&)  or  is  constipated,  with  gray  dry  stools,  and 
(c)  if  it  voids  irritating  urine  which  stains  the  napkin  with  uric  acid 
constitifents. 

The  management  of  the  casein  of  cow's  milk  usually  causes  the  least 
trouble  in  our  milk  formula.  Cow's  milk  casein  may,  however,  be  a  cause 
of  indigestion.  After  a  reduction  of  the  fat  has  failed  to  improve  condi- 
tions, we  are  called  upon  to  prevent  the  coagulation  of  casein  in  tlie 
stomach  by  adding  a  diluent  or  some  alkali  that  will  split  up  the  coagu- 
lated casein.  Sodium  citrate  in  solution,  a  grain  to  one  grain  and  a  half 
for  each  ounce  of  food,  is  sufficient.  Barley  water  may  have  to  be  used 
as  a  diluent,  or  it  may  prove  necessary  to  boil  the  milk.  Sodium  citrate 
in  solution  is  perfectly  reliable  and  long  experience  has  proven  its  value. 

If,  however,  these  measures  fail  and  casein  indigestion  continues,  we 
may  reduce  the  casein  content  of  our  food  formula  and  make  up  the 
deficiency  by  the  addition  of  whey  proteins.  When  this  trouble  is  cor- 
rected, we  can  slowly  increase  the  fat  and  proteins  to  the  original  formula. 
Casein  indigestion  is  revealed  by  large  tough  curds,  loose  alkaline  stools, 
fever,  and  irritability ;  the  latter  will  be  found  a  constitutional  symptom. 

The  sugars  are  the  most  easily  digested  of  the  food  ingredients  of  the 
modified  milk  mixtures,  and  for  this  reason  are  frequently  increased  at 
the  expense  of  the  fat  and  protein.  For  this  reason  we  frequently  find 
sugar  intoxication  in  young  infants.  These  cases  are  associated  with  a 
watery  acid  diarrhea,  producing  irritation  of  the  buttocks.  Fever,  general 
constitutional  symptoms,  much  gas  formation  and  intestinal  catarrh  are 
usually  present.  When  these  symptoms  occur,  it  is  necessary  to  withdraw 
the  sugar  entirely,  or  what  is  possibly  the  best  procedure,  to  substitute 
another  sugar.  Theoretically,  milk  sugar  should  be  the  first  choice,  but 
practical  experience  has  demonstrated  that  cane  sugar  is  better  than 
milk  sugar  and  that  malt  sugar  is  superior  to  both,  so  we  use  malt  sugar 
in  all  of  our  artificially  fed  children. 

HOME  MODIFICATION  OF  COW'S  MILK.— In  feeding  infants  in  the 
home  under  the  physician's  care,  some  modification  or  adjustment  of 
cow's  milk  must  be  made  to  suit  the  individual  infant — this  is  called 
''home  modification"  and  does  not  refer  to  any  exact  changes  to  be  made 
in  the  milk,  except  rendering  it  more  suitable  to  the  baby's  digestive 
capacity  and  nutritional  demands.  Every  physician  of  experience  has 
worked  out,  for  himself,  a  plan  for  modifying  milk,  which  his  clinical 


AETIFICIAL    FEEDING   OF   INFANTS 


513 


experience  has  taught  him  will  serve  his  purpose  hetter  than  any  other 
that  he  has  been  able  to  find,  and  nearly  every  writer  offers  his  own 
formula  for  home  modification  of  milk  by  which  a  certain  degree  of 
accuracy  in  percentage  feeding  may  be  obtained.  This  is  a  true  state- 
ment, and  is  proof  that  there  is  no  single  method  superior  to  all  others. 
The  infant  is  a  changeable  factor,  as  nmch  as  the  milk  ingredients — 
and  the  infant  must  be  modified  as  well  as  the  milk. 

The  prime  object  of  these  methods  is  to  give  the  physician  certain 
rules  so  he  may  arrange  milk  formulas  containing  definite  percentages  of 
pi-otein,  fat,  sugar  and  salts.  Nearly  all  existing  methods  of  feeding  are 
more  or  less  complicated  in  the  sense  that  they  strive  to  give  very  exact 
})ercentages  of  protein,  fat  and  sugar,  in  the  idea  that  the  exact  percentage 
is  necessary  to  success  in  feeding.  This  is  not  true  for  the  formula,  nor 
is  it  true  for  the  infant.  Very  few  physicians  work  out  the  exact  per- 
centage, nor  is  it  necessary.  While  there  can  be  no  objection  to  accurate 
percentages  in  infant  feeding,  yet  the  experience  of  the  world  has  demon- 
strated that  these  accurate  percentages  are  not  absolutely  necessary  to  suc- 
cess, and  that  on  the  whole,  infants  thrive  just  as  well  upon  a  milk 
mixture  which  is  intelligently  modified  so  as  to  contain  protein,  fat,  sugar, 
and  salts  in  fairly  definite  percentages,  and  in  such  quantities  that  the 
infant  will  not  suffer  from  starvation  in  any  one  of  these  important 
ingredients.  By  reason  of  the  many  complicated  methods  given  in  our 
text-books,  most  physicians  resort  to  the  use  of  whole  milk  and  a  diluent 
in  the  form  of  some  malted  sugar  food.  These  simple  mixtures  appeal  to 
the  young  mother  and  the  result  is  that  most  of  our  infants  are  thus 
reared.    The  following  table  is  taken  from  Morse  and  Talbot : 

ANALYSIS  OF  WHOLE  MILK  VARYING  CREAM  PERCENTAGES 
SKIMMED  AND  SEPARATED  MILKS 


Fat 

Milk  Sugar 

4.00 

4.50 

7.00 

4.45 

10.00 

4.40 

16.00 

4.20 

32.00 

3.20 

1.00 

5.00 

0.25 

5.00 

0.25 

5.00 

Protein 


Whole  Milk... 
7%  Cream... 
10%  "  ... 
16%  «  ... 
32%  «  ... 
Skimmed  Milk 
Separated  " 
Whey 


3.50 
3.40 
3.25 
3.05 
2.50 
3.55 
3.65 
0.90 


While  the  simplicity  of  the  whole  milk  method  of  modifying  infant 
feeding  has  made  it  popular,  there  is  no  question  that  much  better  results 


514  REQUIREMENTS    OF    INFANT    FEEDING 

can  be  obtained  by  a  method  which  uses  top  milk  as  well  as  whole  milk 
in  the  preparation  of  infant  foods.  In  this  way  the  fat  percentages  can 
be  better  adapted  to  the  nutritional  demands  of  the  infant. 

Feeding  may  be  greatly  simplified  and  its  efficacy  not  materially 
diminished  by  making  all  food  formulae  from  three  ingredients,  viz., 
1,  whole  milk,  which  to  simplify  computations  one  may  assume  contains 
4  per  cent  fat,  4  per  cent  protein  and  4  per  cent  of  sugar;  2,  top  milk, 
containing  7  per  cent  cream — this  is  obtained  by  taking  the  top  half  of 
the  milk  after  it  has  stood  for  two  hours ;  this  contains  very  nearly  7  per 
cent  fat,  4  per  cent  protein  and  4  per  cent  sugar ;  3,  a  carbohydrate  solu- 
tion made  of  sugars  or  starches  containing  one-half  ounce  of  carbohydrate 
to  the  pint. 

In  infants  under  six  months  of  age,  because  of  the  great  dilution  of 
the  milk,  the  7  per  cent  top  milk  should  be  used,  so  as  not  to  get  a  too 
low  percentage  of  fat.  In  infants  over  six  months  of  age  whole  milk  may 
be  used. 

In  making  modified  milk  mixtures  from  these  ingredients  th&  physi- 
cian should  be  guided  by  the  principles  underlying  the  artificial  feeding 
of  infants,  as  pointed  out  in  the  earlier  portion  of  this  chapter. 

In  the  table  it  is  shown  how  the  ingredients  may  be  combined  in  the 
production  of  an  infant  food  which  will  answer  all  practical  purposes. 
It  possesses  the  proper  number  of  calories,  and  contains  the  important 
per  cent  of  protein,  fat,  sugar  and  salts  in  such  relative  quantities  that 
the  infant  will  be  satisfied.  After  all,  the  true  test  of  feeding  is  the  child 
itself.  If  the  infant  gains  in  weight,  six  to  eight  ounces  per  week  while 
under  four  months ;  sleeps  well  from  twelve  to  fifteen  hours  in  the  twenty- 
four;  doubles  its  birth-weight  at  six  months  and  triples  it  at  one  year, 
we  may  well  feel  that  the  food  is  meeting  all  requirements. 

Between  the  sixth  and  twelfth  month  the  food  of  the  average  well 
infant  should  be  supplemented  by  the  addition  of  orange  juice,  raw  egg 
albumen,  thick  cereal  gruels,  meat  juice  and  meat  broths.  All  this  addi- 
tional food  should  precede  or  follow  the  bottle,  except  orange  juice,  which 
should  be  given  at  least  one  hour  after  the  bottle. 

Milk  should  always  remain  the  chief  food  of  the  infant  and  can  be 
continued  until  the  third  year,  or  until  the  child  has  been  taught 
to  chew  thoroughly  the  food  suitable  for  its  age. 

After  nursing,  any  food  remaining  in  the  bottle  must  be  thrown  away. 
Flies  should  never  be  allowed  to  touch  the  baby,  food,  or  utensils.  It 
should  be  understood  that  the  mother  or  nurse  will  never  touch  the  nipple 
with  their  lips. 


ARTIFICIAL    FEEDING    OF    INFANTS  515 

The  temperature  of  the  milk  may  be  tested  before  giving  it  to  the 
baby  by  allowing  a  few  drops  to  fall  on  the  back  of  the  hand. 

The  bottle  must  be  held  inverted  by  the  mother  or  nurse  during  the 
feeding,  so  that  the  child  will  not  suck  air. 

If  the  milk  flows  too  freely,  ofttimes  a  most  perplexing  problem  in 
artificial  feeding,  the  nipple  needs  changing,  or  possibly,  a  light  gauze 
packing  is  required. 

The  time  required  to  take  six  to  eight  ounces  of  food  should  not 
exceed  iwenty-five  minutes  of  continuous  nursing.  This  is  necessary  to 
develop  the  salivary  glands  and  promote  good  digestion. 

Regularity  is  of  prime  importance.  The  number  and  length  of  inter- 
vals should  be  about  the  same  as  those  given  for  infants  at  the  breast. 

Water  is  of  vital  necessity  and  must  be  given  at  least  three  times  a 
day ;  this  is  best  done  from  a  bottle,  two  to  three  ounces  at  a  time.  I  am 
in  the  habit  of  ordering  a  small  quantity  of  sugar  or  soda  mint,  or  both, 
in  the  bottle.     This  is  of  value  if  the  child  is  constipated. 

It  is  a  good  rule  to  start  with  formulas  of  low  percentages  in  com- 
mencing artificial  feeding  in  normal  babies.  This  is  true  of  fats  and 
proteins.  Taking  the  mother's  milk  as  a  standard,  the  percentage  of  sugar 
and  protein  may  be  about  the  same,  but  the  fats  should  be  about  one-half, 
remembering  that  temporary  error  on  the  side  of  underfeeding  is  much 
easier  of  correction  than  the  more  common  mistake  of  overfeeding. 

The  final  rule  is  to  keep  the  child  in  a  cool,  quiet,  and  dark  room 
where  all  external  irritations  are  reduced  to  a  minimum. 

Summary  of  Rules  to  Be  Observed  in  Artificial  Feeding 

The  aseptic  care  of  the  bottles,  nipples  and  utensils,  including  the 
person  of  the  nurse  or  mother,  cannot  be  over-emphasized.  This  rule  is 
as  important  as  clean  milk,  and  without  clean  milk  the  first  and  most 
important  link  in  the  chain  is  broken.  The  once  familiar  death-trap 
known  as  the  long-tube  nursing  bottle,  still  frequently  seen  in  children's 
dispensaries,  has  at  last  attracted  the  attention  of  legislators,  so  that  in 
many  localities  not  only  the  use,  but  even  the  sale  is  prohibited  by  law. 

In  the  home  modification  of  milk  the  mother  or  nurse  must  be  care- 
fully instructed  by  the  attending  physician  in  regard  to  all  details.  All 
the  necessary  utensils  should  be  on  hand  for  the  proper  and  scientific 
preparation  of  the  baby's  aliment.  These  include  a  good  medium  sized 
ice  box,  tivo  siphons,  sterilizer,  or  pasteurizer,  thermometer  registering 
to  212°  F.,  a  dozen  graduated  feeding  tubes  or  bottles  (large  mouth  with- 
out shoulder  with  small  lip),  bottle  bimshes,  absorbent  cotton,  straining 


516  EEQUIREMEXTS    OF    IXFA:N^T    FEEDING 

gauze,  non-ahsorhent  cotton  for  use  as  stoppers,  mixing  pitcher,  glass 
funnel,  tall  cup  for  warming  bottle,  six  black  rubber  nipples  (reversible 
for  cleaning),  package  of  bicarbonate  of  soda  and  boric  acid. 

Lime  ivater  should  be  kept  in  a  well-corked  bottle.  The  sugar  (malt 
or  cane)  solution  should  be  prepared  fresh  for  each  day's  use. 

The  supply  of  food  should  be  prepared  once  or  twice  in  the  twenty- 
four  hours,  dependent  upon  the  time  of  the  milk  delivery,  and  the  number 
of  tubes  to  be  used.  The  milk  should  always  be  kept  on  ice  before  and 
after  preparation. 

All  bottles  and  utensils  should  be  washed  with  hot  soap-suds,  then 
boiled  and  rinsed.  The  feeding  tubes,  after  boiling,  should  be  filled  with 
hot  boric  acid  or  soda  solution  and  left  covered  until  used  again.  The 
tubes,  when  filled,  should  be  stoppered  with  non-absorbent  cotton  so  that 
in  cooling  the  air  may  pass  through.  After  warming  to  about  100°  F. 
by  standing  the  bottle  in  a  cup  of  hot  water,  the  cotton  in  the  bottle  is 
replaced  by  the  nipple.  The  nipples  must  be  boiled  daily  and  then  kept 
dry  in  a  closed  box. 

eefere:nces 

1.  Davis.    Am.  J.  Dis.  Child.,  1913,  vol.  v,  p.  234. 

2.  Holt.     J.  Am.  Med.  Assn.,  1908,  vol.  li. 

3.  KoPLiK,  Henky.    Ibid.,  1912,  vol.  Iviii,  p.  Y5. 

4.  Peitchaed,  Eeic.     Infant  Nutrition  and  Management,  1914. 

5.  Geaham.    J.  Am.  Med.  Assn.,  1908,  vol.  liv,  p.  1045. 

6.  Holt.     Ibid.,  1910,  vol.  liv,  p.  682. 

7.  Davis,  A.  J.     Dis.  of  Child.,  1913,  vol.  v,  p.  234. 

8.  LuLiNG.     These  de  Paris,  1900. 

9.  Aemsteong.     British  J.  Dis.  of  Child.,  1904,  vol.  i,  p.  115. 
10.  Escheeich.     Fortschr.  d.  Med.,  1885,  vol.  iii,  p.  231. 

CoH]sr  and  Newman.     Virchow's  Arch.  f.  path.  Anat.,  1891,  vol, 

cxxvi,  p.  391. 
Palleske.     Virchow's  Arch.,  1892,  vol.  cxxx,  p.  185. 
HoNiGMANN.    Ztschr.  of  Hyg.  u.  Infect.,  1893,  vol.  xiv,  p.  207. 
Eingel.    Miinch.  med.  Wchnschr.,  1893,  vol.  xl,  p.  513. 
Genond.     Sur  la  presence  du  staphlocoque  dans  le  lait  des  aecou- 

chees  bien  portantes.     These  de  Lyon,  1894. 
Knochenstieen.     Hyg.  Rundschau,  1894,  vol.  iv,  p.  231. 
Halleue.     Inaug.  Diss.,  Leipzig,  1893. 
Bbumm.    Arch.  f.  Gynaekol.,  1886,  vol.  xxvii,  p.  461. 


eefere:n^ces  517 

Merit.     These  de  Paris,  1887. 

JoHANNESSEN.    Jalirb.  f.  Kinderli.,  1895,  vol.  xxxix,  p.  398. 

KoEPEK.     Inaiig.  Diss.,  Marburg,  1896. 

KoESTLiN.    Arch.  f.  Gynaekol.,  1897,  vol.  liii,  p.  201. 

11.  Uhlentkuth   and   Mulzee.     Med.   Wchnschr.,   1913,   vol.   xxxix, 

No.  19. 

12.  Lawrence.    Boston  Med.  and  Surg.  J.,  1909,  vol.  clxi,  p.  152. 

13.  MoEO.     Jahrb.  f.  Kinderh.,  vol.  lii,  p.   542. 

14.  Engel.      Sommerfield's    Handbuch    der    Milchkunde,    Wiesbaden, 

1909,  p.  774,  Konig,  Note  9. 

15.  Cramer.     Klinische  Beitriige  zur  Frage  der  Kiinstlichen  Ernah- 

rung  des  Neugeborenen,  Inaug.  Diss.,  Breslau,  1896  ;  taken  from 
Czernj  and  Keller,  Des  Kindes  Erniihrung,  Ernahrungs- 
storungen  und  Emiihrungstherapie,  Leipzig  u.  Wien,  1906,  vol. 
i,  p.  356. 

16.  CzERNY  and  Keller.     Ibid.,  p.  353. 

17.     .     Ibid.,  p.  458. 

18.  RiETSCHAL.     Jahrb.  f.  Kinderh.,  vol.  Ixiv,  p.  125. 

19.     .     Loc.  cit,  p.  407. 

20.  ExGEL.     Sommerf eld's    Handbuch    der    Milchkunde,    Wiesbaden, 

1909. 

21.     .     Arch.  f.  Kinderh.,  1906,  vol.  xliii,  p.  181. 

22.  Moll.    Ibid.,  1908,  vol.  xlviii,  p.  161. 

23.  Skvorlzov.    Russki  Vratch,  vol.  ii,  p.  1392,  Ref.  Chem.  Abstract, 

1913,  vol.  vii,  No.  18. 

24.  Deniges.     Contribution  a  I'etude  des  lactoses,  Paris,  1892. 
BoMMARTixi.     Rev.  gen.  du  lait.,  1896,  vol.  ii.  No.  1. 

25.  PoRCHER.     Biochem.  Ztschr.,  1909-10,  vol.  xxiii,  p.  370. 
Patox  and  Cathcart.     J.  Physiol.,  1911,  vol.  xliii,  p.  179. 

26.  Pfeiffer.     Verb.  II.  Versamml.  d.  Gesellsdi.  f.  Kinderh.,  Wien, 

1894,  p.  131. 

27.  ScHLossMAi^N.     Arch.  f.  Kinderh.,  1900,  vol.  xxx,  p.  324. 

28.  Lust.     Monatschr.  f.  Kinderh.,  1913,  vol.  xi,  p.  236. 

29.  ScHAFER  and  MacKenzie.     Proc.  Roy.  Soc,  London  (B),  1911, 

vol.  Ixxiv,  p.  16. 

30.  Hammond.     Quart.  J.  Exper.  Physiol.,  1913,  vol.  vi,  p.  311. 

31.  Gavin.     Ibid.,  1911,  vol.  vi,  p.  13. 

32.  Mackenzie.     Ibid.,  1911,  vol.  iv,  p.  305. 

Ott  and  Scott.    Therap.  Gazet,  1911,  vol.  xxxv,  p.  689. 

33.  Aschner  and  Grigorl     Arch.  Gyn.,  vol.  xeiv,  No.  3. 
133 


518  REQUIREMENTS    OF    INFANT    FEEDING 

34.  Basch.     Mlinch.  med.  Wchnschr.,  1911,  vol.  Iviii,  p.  2261. 

35.  Wolf.     Zentralbl.  f.  Biochem.  u.  Biophys.,  1913,  vol.  xiv,  p.  224. 

36.  Chatin  and  Rendu.    Lyon  med.,  1912,  vol.  cxvii,  p.  161. 

37.  Morse  and  Talbot.     Diseases  of  Nutrition  and  Infant  Feeding. 

38.  Cramer.     Miinch.  med.  Wchnschr.,  1909,  vol.  Ivi,  p.  1521. 

39.  Basch.     Ihid.,  1911,  vol.  Iviii,  p.  2266. 

40.  D'Errico.     La  Pediatria,  Abstr.  in  Jahrb.  f.  Kinderh.,  1910,  vol. 

xxii,  p.  504. 

41.  Oppenheimer^s  Handbuch  der  Biochemie,  Jena,  1910,  vol.  iii,  p. 

403. 

42.  KoNiG,  J.    Des  Menschen  Nahrungs-  und  Genussmittel,  1904,  Ber- 

lin, vol.  ii,  p.  598. 

43.  KiRsciiNER.    Handb.  d.  Milchwirtschaft,  Berlin,  1907,  pp.  7,  40. 

44.  Bartiie.     Quoted  in  Maly's  Jahres,  190G,  p.  230. 

45.  Fleischmanist.     Lehrbuch  der  Milchwirtschaft,   3rd  ed.,   Leipzig, 

1901,  p.  57. 

46.  Hammarsten.    Text-book  of  Phys.  Chemistry,  New  York,  1912. 

47.  Camaille,  C.  R.    63,  692. 

48.  Backhans.    Quoted  in  Maly's  Jahres,  1906,  p.  299. 

49.  BuNGE.     Ztschr.  f.  Biol.,  1874,  vol.  x,  p.  309. 

50.  Abderhalden.     Ueber  Sauglings-Ernahrung,  Berlin,  1912,  p.  55. 

51.  Soldner.     Die  Landwirthsch.  Versuchsstat,  1888,  vol.  XXV,  p.  361 ; 

quoted  from   Voltz   in   Oppenheimer's   Handbuch,   vol.   iii,   i, 
■  p.    398. 

52.  Richmond.     Dairy  Chemistry.,  Phila.,  1899. 

53.  ScHLOSs.    Loc.  cit..  Dairy  Chemistry,  Phila.,  1899. 

54.  Funk,    Casimir.      Die   Vitamin  etc.,   Wiesbaden,   pub.   by   J.    F. 

Bergman,  1914. 


CHAPTER   XVI 


SPECIAL   DIETS 

H.  Lyoxs  Hunt/jM.D.,  L.R.C.S.  and  P.  (Edinburgh),  L.F.P.  and  S. 

(Glasgow) 

Food,  and  only  food,  makes  hlood,  and  blood,  as  we  know,  makes  body;  so  that 
our  body  structure  is  dependent  upon,  and  only  upon,  the  food  we  eat. 

Vegetable  Diet:  Vegetable  Diet  and  Energy;  Vegetable  Diet  and  Health; 

Vegetable   versus   Animal   Protein;    Summary. 
Meat  Diet:  The  Salisbury  Diet;  Zymotherapy. 
Fruit  Diet:  Fruit  Diet  in  Disease;  Lemon  Cure;  Grape  Cure. 
Tufnell  and  Bellingham  Diets. 
Weir  Mitchell  Diet. 
Training  Diet. 
Keducing  Diet. 

Diet  for  Professional  Singers  and   Lecturers. 
The  Dry  Cure. 
The  Yolk  Cure. 
Milk  Cures:  Kumiss  Cure;  Matzoon  Cure;  Buttermilk;  Cure;  Sour  Milk 

Cure;  Milk  Cure;  Skim  Milk  Cure;  Whey  Cure. 

From  time  immemorial  man  has  fed  on  the  fruits  of  the  earth  and 
the  flesh  of  animals.  At  certain  epochs  in  his  history,  under  the  sway 
of  philosophic  speculation  or  religious  tenets,  sometimes  on  account  of 
careful  hygienic  considerations,  or  even  under  force  of  necessity,  he  has, 
voluntarily  or  not,  subjected  himself  to  special  forms  of  diet,  sometimes 
eating  only  fruits  and  herbs,  sometimes  adding  milk  to  his  fruits  and 
vegetables.  At  other  times,  on  the  contrary,  his  alimentation  has  been  ex- 
clusively from  the  flesh  of  animals,  and  again  he  has  seen  fit  to  subsist 
upon  a  mixed  diet,  to  the  rigid  exclusion  of  all  meat.  These  exclusive 
methods  of  alimentation  have  led  to  favorable  hygienic  and  dietetic  re- 
sults which  find  ready  application  in  trophotherapeutic  treatment. 

519 


520  SPECIAL    DIETS 

Various  systems  of  special  diets  and  diet  cures  have  been  devised  to 
meet  the  requirements  of  disease  or  the  fancies  of  the  faddist.  Some  of 
these  consist  solely  in  the  elimination  of  certain  articles  of  food  from  the 
dietary,  due  to  esthetic  tastes  or  humanitarian  principles.  In  some  in- 
stances the  particular  modification  is  based  on  trophotherapeutic  reason- 
ing with  a  view  of  economic  simplicity,  the  desire  to  give  the  digestive 
apparatus  a  complete  rest  from  some  particular  food  constituent,  or  the 
necessity  of  curtailing  the  amount  of  nutrients  in  the  dietary  without 
reducing  the  actual  quantity  of  the  diet  or  of  limiting  the  total  caloric 
value.  Many  of  the  special  diets  and  diet  cures  which  embody  this  object 
are  outlined  in  the  present  chapter;  and  those  prescribed  in  obesity  are 
referred  to  in  the  section  dealing  with  Diet  in  Diseases  of  Metabolism 
(Volume  III,  Chapter  XII).  The  dietaries  here  considered  are  of  prac- 
tical use  in  various  conditions  of  health  and  disease,  in  different  indi- 
viduals in  different  climates,  or  in  the  same  individuals  under  different 
environments. 

VEGETABLE    DIET 

Vegetarianism  (1),  or  a  vegetarian  diet,  will  be  the  first  of  the  special 
diets  and  diet  cures  to  receive  attention,  because,  in  one  form  or  another, 
it  is,  and  has  long  been,  the  alimentation  of  entire  races  of  people 
numbering  many  millions,  and  of  late  years  has  become  a  fad  with  many 
Americans  and  Europeans,  who  find  it  more  economical  to  patronize  the 
green  grocer  than  the  butcher,  and  who  believe,  in  many  instances,  that  a 
vegetable  dietary  is  conducive  to  health,  longevity,  good  temper  and  a 
mildness  of  disposition  which  a  carnivorous  dietary  obliterates.  Often, 
too,  believers  in  this  special  form  of  dietary  object  to  the  flesh  of  animals 
for  esthetic  or  religious  reasons,  since  they  consider  the  slaughter  of  ani- 
mals unjustifiable  to  furnish  food  for  man. 

A  dietary  which  excluded  the  flesh  of  all  animals  was  at  first  a  re- 
ligious practice.  The  Hindoos,  followers  of  Brahma  and  Buddha,  believ- 
ers in  the  doctrine  of  the  transmigration  of  the  soul,  still  hold  to  the  teach- 
ing that  the  spirit  can  migrate  from  man  to  animals,  which  are  our  in- 
ferior brothers.  It  has,  therefore,  always  been  repugnant  to  followers  of 
this  cult  even  to  think  of  eating  the  flesh  of  an  animal,  which  to  them  is 
a  kind  of  sacrilegious  cannibalism.  For  a  similar  reason  the  religit)us  be- 
liefs of  the  ancient  Egyptians  forbade  the  use  of  meat,  this  doctrine  hav- 
ing been  brought  by  Pythagoras(2)  from  that  country  into  Greece,  whence 
it  has  been  transmitted  to  us  by  time.  The  human  race  is  omnivorous  by 
instinct,  by  its  dentition,  by  its  digestive  secretion,  and  by  its  need  of  ac- 


VEGETABLE    DIET  521 

tivity.  To  work  quickly  and  well,  tlio  modern  man,  especially,  must  have 
a  stimulating  dietary  which  will  furnish  him  with  the  most  active  and 
most  digestible  plastic  matter  in  the  smallest  volume.  A  diet  of  meat  and 
vegetables  seems  to  agree  with  him  from  every  point  of  view. 

The  strict  vegetarian  partakes  of  no  animal  food,  and  no  tubers  nor 
foods  grown  under  ground,  limiting  his  alimentation  entirely  to  fruits 
and  vegetables  grown  in  the  sunlight.  Many  vegetarians,  however,  in 
addition  to  vegetables,  consume  milk,  butter,  cheese  and  eggs,  and  are 
classed  as  lacto-vegetarians.  In  reality  they  are  no  more  vegetarians  than 
the  man  who  eats  meat,  lish  or  fowl.  The  alimentation  of  the  lacto-vege- 
tarian,  consisting  of  milk,  cheese,  butter,  eggs,  cereals,  legumes,  fruits, 
nuts  and  other  vegetables,  is  advantageous  to  many  people  and  more  par- 
ticularly in  the  trophotherapeutie  treatment  of  certain  types  of  disease. 
Vegetarianism  has  its  advantages  in  that  its  supporters  do  not  overeat 
while  getting  a  fairly  bulky  meal;  the  amount  of  protein  consumed  is 
smaller  and  the  proportion  absorbed  is  less  from  a  vegetarian  diet  than 
from  a  mixed  diet,  which  is  of  great  advantage  to  many  patients.  A  lacto- 
vegetarian  dietary,  such  as  the  following  from  Tibbles(3),  is  valuable  in 
the  dietetic  treatment  of  high  arterial  tension,  the  forerunner  of  arterio- 
sclerosis, of  some  forms  of  renal  disease,  as  albuminuria,  and  of  Graves' 
disease,  gout,  calculi,  hepatic  troubles,  rheumatism,  intestinal  toxemia  and 
intestinal  fermentation,  chronic  skin  diseases  and  chronic  nervous  affec- 
tions. 

LACTO-VEGETARIAN  DIET 

Breakfast: 

Milk,  whole  meal  bread,  butter,  one  egg. 

Lunch: 

Baked  beans  and  tomatoes,  potatoes,  cabbage,  stewed  fruit,  bread,  cheese,  and 
salad. 
Dinner: 

Lentil  soup  or  oatmeal  porridge,  bread  and  butter,  dates  and  walnuts,  or  grapes 
and  bananas. 

This  dietary  can  be  varied  in  many  ways.  The  use  of  sauces,  such 
as  walnut  and  mushroom  ketchup,  or  ripe  tomatoes,  added  to  beans  or 
macaroni,  makes  them  more  palatable  and  gives  zest  to  the  appetite  and 
at  the  same  time  provokes  the  stimulation  of  the  secretion  of  gastric  juice. 
Beans  and  peas  boiled  with  savory  herbs — ^mint,  thyme,  savory,  marjoram, 
etc. — are  more  palatable  and  better  flavored  than  when  cooked  without 
them.  Lunch  is  generally  more  difficult  to  provide  than  the  other  meals. 
The  following  dietaries  outline  lacto-vegetarian  lunches  for  a  week: 


522  SPECIAL   DIETS 

LACTO-VEGETARIAN  LUNCHES 
Monday: 

Steamed  rice  and  tomatoes,  with  grated  cheese;   boiled  cabbage  or  other  green 
vegetables;  whole  meal  biscuits;   custard  pudding. 
Tuesday: 

Steamed  broad  beans  and  macaroni,  with  parsley  sauce;   steamed  green  vege- 
tables; potatoes  cooked  in  their  skins. 
Wednesday: 

Nut-roast,  mushroom  gravy;    steamed  vegetables;  plain  steamed  pudding  with 
jam  or  syrup. 
Thursday:  , 

Macaroni  and  cheese,  with  apple  sauce  and  steamed  potatoes;  ginger  pudding; 
fruit. 
Friday: 

Baked  Irish  stew  containing  nut-meal  or  peas  or  beans  in  place  of  meat;   milk 
pudding;   unfermented  bread;   cheese. 
Saturday: 

Lentil-roast  with  apple  sauce  or  gravy;    boiled  cabbage;    baked  or  steamed 
potatoes;  maizene  pudding;  nuts  and  fruit. 
Sunday: 

Savory  pie,  consisting  of  steamed  haricot  beans  and  vegetables;  or  macaroni 
and  eggs,  moistened  with  milk  and  seasoned;  baked  potatoes;  tomatoes  and 
salad;  ground  rice,  blanc  mange;  fruit. 

It  is  no  longer  questioned  that  a  dietary  composed  entirely  of  vege- 
tables will  supply  all  the  food  constituents,  carbohydrates,  fats  and  pro- 
teins. A  menu  can  be  planned  so  as  to  supply  all  the  necessary  food  ele- 
ments requisite  for  body  metabolism.  The  nitrogenous  matter  obtained 
from  vegetables,  however,  is  less  easily  digested  than  that  from  animal 
foods,  and  a  much  larger  percentage  passes  from  the  alimentary  tract 
unutilized.  Individuals  subsisting  entirely  on  a  strict  vegetarian  diet  for 
any  prolonged  period  of  time  are  apt  to  lose  strength  as  well  as  physical 
and  mental  vigor  and  endurance  and  show  languor  and  disinclination  for 
work,  and  they  become  less  able  to  resist  disease (4,  5).  Laborers  are 
unable  to  perform  the  same  amount  of  work  they  could  accomplish  on  a 
dietary  containing  animal  food.  As  previously  stated,  the  animal  king- 
dom supplies  man  with  protein  food,  and  the  vegetable  kingdom  provides 
carbohydrates  except  honey;  fats  being  derived  about  equally  from  both 
sources.  The  percentage  of  starch  in  different  vegetables  varies  greatly, 
being  highest  in  tubers.  Green  vegetables  are  practically  fat-free,  con- 
taining a  very  small  percentage  of  protein,  one-tenth  of  which  is  lost  in 
cooking,  and  from  two  to  eight  per  cent  of  starch,  of  which  one-third  is  lost 
in  cooking.     They  possess  the  advantage  of  being  able  to  take  up  a  great 


VEGETABLE    DIET  523 

deal  of  fat  during  the  process  of  cooking.  Fats  are  negligible  constituents 
of  vegetables,  but  are  apparently  quite  as  nutritious  and  even  more  di- 
gestible than  animal  fats.  A  careful  consideration  of  the  elementary  con- 
stituents of  a  vegetable  dietary  shows  that  the  principal  advantage  of  a 
strict  vegetable  diet  is  the  reduction  of  all  protein,  notwithstanding  a  large 
bulk  of  vegetables  may  be  taken.  The  exclusion  of  animal  foods,  with  the 
exception  of  eggs,  milk  and  milk  products,  from  the  diet  is  strenuously 
advocated  by  certain  sentimentalists  who  are  opposed  to  slaughtering  ani- 
mals for  food. 

According  to  Edmund  Caultey(6),  universal  lacto-vegetarianism  is  an 
impossibility. 

Carried  out  thoroughly  to  its  logical  conclusion  it  would  have  a  most  pro- 
found effect  on  life  generally.  Under  such  a  scheme  of  diet  all  animals  except 
those  used  for  draught  purposes  and  pleasure  would  gradually  be  abolished. 
Were  fowls  only  kept  to  supply  eggs  and  feathers,  the  price  of  eggs  would  rise 
considerably.  So,  too,  the  supply  of  milk  would  be  insufficient  and  its  price 
prohibitive,  for  cattle  could  not  be  kept  profitably  for  the  supply  of  milk  and 
leather  alone.  Woolen  clothing  would  become  the  luxury  of  the  rich.  The  bulk 
of  the  grass  grown  would  be  absolutely  wasted  unless  the  science  of  the  vege- 
tarian were  able  to  prepare  from  it  a  food  for  man. 

The  productive  value  would  be,  however,  increased  if  the  grass  plains  were 
converted  into  arable  land  for  the  growth  of  cereals  and  sugar  beets  and  into 
orchards  for  fruits  and  nuts.  We  should  have  an  insufficient  and  expensive  sup- 
ply of  milk,  milk  products,  and  eggs,  wool  and  leather.  We  should  be  dependent 
on  cotton  and  linen  for  clothing  and  on  compressed  cellulose  for  boots  and  many 
other  purposes. 

But  although  universal  vegetarianism  is  opposed  to  the  scheme  of  na- 
ture, there  are  cases  in  which  the  diet,  or  one  modified  by  the  addition 
of  milk  and  eggs,  is  particularly  suitable.  As  has  been  stated  above,  its 
advantage  largely  depends  on  a  relative  starvation,  when  compared  with 
the  previous  mixed  diet.  The  patient  no  longer  overeats.  Vegetarians 
claim  that  they  live  longer  and  are  healthier,  physically  and  morally,  than 
flesh-oaters,  and  it  is  true  that  they  may  be  healthier,  physically,  if  they 
have  been  subject  previously  to  ailments  due  to  an  excess  of  nitrogenous 
food  or  overeating  generally.  The  diet  is  more  suited  to  those  engaged 
in  hard  physical  work,  for  they  sweat  freely  and  get  rid  of  the  excess  of 
water  in  the  diet,  and  they  require  much  carbohydrate  food  to  provide  for 
muscular  energy.  A  sedentary  person  on  a  vegetarian  diet  is  liable  to 
develop  a  distended,  flatulent  abdomen,  watery  blood,  and  diarrhea  from 
the  excessive  peristalsis  set  up,  while  the  excess  of  waste  products  puts 
extra  work  on  the  organs  of  excretion. 


524  SPECIAL    DIETS 

Tibbles(3)  does  not  agree  with  the  assertion  that  vegetarianism  leads 
to  mildness  of  temper  or  to  gentleness  of  disposition.  He  points  out  that 
the  buffalo,  the  rhinoceros  and  the  Chinese  pirate,  all  vegetarians,  are 
equally  remarkable  for  their  cunning  and  ferocity.  It  is  universally 
known  that  the  carnivora  are  more  active,  more  alert  and  more  powerful 
than  the  herbivora,  while  the  meat-eating  races  of  man  are  physically  supe- 
rior to  those  who  subsist  entirely  on  a  vegetable  diet.  He  also  calls  atten- 
tion to  the  superior  physique  of  the  American  or  European  soldier  over 
that  of  the  Japanese  or  Chinese.  Again,  the  races  of  mankind  who  subsist 
on  a  mixed  dietary  are  more  progressive  and  more  alert  than  the  vege- 
table-eating races.  We  learned  when  studying  Protein  and  I^utrition  that 
the  Japanese  as  a  race  have  made  wonderful  progress  since  the  adoption  of 
a  larger  protein  ration  and  especially  since  eating  animal  food.  This 
same  statement  applies  equally  to  the  Chinese,  Siamese  and  Burmese. 

Vegetable  Diet  and  Energy. — The  principal  influence  of  a  vegetarian 
diet  on  metabolism  is  a  lessening  of  many  of  the  vital  forces.  According 
to  Tibbies,  "The  influence  of  vegetarian  diet  is  to  slow  down  many  of  the 
vital  processes,  to  make  the  person,  if  anything,  less  energetic,  or  of  a 
quieter  disposition  only  in  proportion  as  all  his  functions  become  some- 
what more  languid.  That  animal  food  is  proper  for  children  is  suggested 
by  the  fact  that  milk  is  the  natural  food  of  infants  and  young  children. 
It  may  be  admitted  that  less  animal  food  than  the  amount  usually  con- 
sumed is  quite  sufficient,  and  it  is  probable  that  two-thirds  of  the  amount 
of  protein  required  might  be  derived  from  vegetable  sources."  Hueppe 
is  the  authority  for  the  statement  that  "man  was  originally  a  mixed 
feeder,  but  evolved  into  a  flesh-eater,  and  lastly  into  a  vegetarian;  but 
vegetarianism  only  became  possible  after  the  introduction  of  fire  and  dis- 
covery of  the  art  of  cooking.  Man  has  neither  the  teeth  nor  the  gut  of  a 
vegetarian  animal,  or  he  would  naturally  graze  in  the  fields  in  the  sum- 
mer, and  in  winter  eats  oats  from  a  manger." 

As  a  source  of  energy,  there  can  be  no  possible  advantage  in  adhering 
to  a  vegetable  dietary,  but  on  the  other  hand,  there  is  a  decided  disad- 
vantage owing  to  the  vegetarian  diet  being  more  difficult  of  digestion.  The 
amount  of  energy  expended  in  the  performance  of  bodily  functions  and 
the  amount  expended  under  various  conditions  and  circumstances  has  been 
fully  discussed  in  a  previous  chapter.  It  has  already  been  stated  that  the 
required  energy  can  be  obtained  from  a  purely  vegetarian  diet  provided 
the  amount  consumed  is  sufficient,  but  a  strict  vegetarian  diet  does  not 
appear  to  give  the  amount  of  strength  obtained  from  a  mixed  diet.  This 
view  is  generally  held  and  is  well  expressed  by  Tibbies (3)  : 


VEGETABLE    DIET  .  525 

No  vegetarian  animal  can  lift  the  weight  of  his  own  body,  not  even  the  horse, 
ox,  camel,  or  elephant.  On  the  other  hand,  the  carnivorous  lion,  gripping  a  calf 
his  own  weight,  can  jump  a  hurdle  six  feet  high.  The  lifting  power  of  man,  the 
mixed  feeder,  exceeds  that  of  any  other  mammal.  It  is  recorded  of  Louis  Cyr 
that  he  lifted  2,672  pounds;  of  Little,  that  he  carried  1,560  pounds  for  fifteen 
steps;  of  a  Tyrolese,  that  in  six  hours  he  carried  a  load  weighing  262  pounds  up 
an  ascent  5,000  feet  high.  A  laborer  weighing  165  pounds,  working  around  the 
New  York  docks,  will  many  times  a  day  carry  a  sack  weighing  220  pounds.  A 
negro  helper  on  the  freight  trains  in  the  South  will  carry  a  SOO-j^ound  bale  of 
cotton  and  think  nothing  of  such  a  feat.  The  street  porters  of  Salonica  and 
Constantinople,  who  feed  on  pillaf  of  rice  and  figs,  with  a  little  meat,  are  noted 
for  their  proverbial  strength.  It  is  not  at  all  unusual  to  see  one  of  them  carrying 
a  grand  piano  about  the  streets  on  his  back.  Hence  the  saying,  "As  strong  as 
a  Turk." 

Vegetable  Diet  and  Health — Vegetarian  faddists  claim  that  a  strict 
vegetable  diet  is  more  healthful  than  a  mixed  diet,  also  declare  that 
it  tends  to  health  and  longevity,  but  statistics  show  that  the  vegetarian  is 
just  as  liable  to  disease,  and  possibly  more  so,  through  his  food  than  the 
flesh  eater.  Vegetarians  also  claim  that  meat  causes  diseases  of  the  liver, 
gout,  stone,  gravel,  chronic  rheumatism,  skin  diseases,  disturbances  of  the 
vascular  system,  arteriosclerosis,  and  other  similar  diseases;  that  pto- 
maine poisoning  may  follow  the  ingestion  of  animal  food;  that  the  animal 
whose  flesh  is  consumed  may  have  been  the  subject  of  anthrax,  glanders, 
foot-and-mouth  disease,  or  some  of  the  various  other  maladies  communi- 
cable to  man.  The}^  also  assert  that  oysters  and  other  shellfish  are  a 
causative  factor  in  outbreaks  of  typhoid  fever.  Many  instances,  however, 
can  be  cited  to  show  that  a  vegetable  diet  may  also  be  the  means  of  dis- 
seminating diseases.  Bread  and  other  starchy  foods  from  the  vegetable 
kingdom  taken  in  excess  lead  to  indigestion,  flatulence,  acidity,  congestion 
of  the  liver,  and  hemorrhoids,  and  tend  to  obesity,  while  overmilled  rice 
is  the  cause  of  that  scourge  of  the  East  known  as  beriberi,  or  kakke. 
While  sugar  possesses  enormous  value  as  a  provider  of  energy,  if  ingested 
in  excess  it  will  produce  evils  similar  to  those  following  an  excels  of 
starchy  foods,  especially  catarrh  of  the  stomach.  Again,  the  ingestion  of 
hard  fruit,  nuts  and  fibrous  vegetables  may  be  a  contributing  cause  to 
digestive  difficulties.  Animal  foods  are  by  no  means  the  only  source 
through  which  disease  may  be  transmitted.  Practitioners  in  the  tropics 
invariably  give  this  advice,  "Eat  no  uncooked  vegetable,  nor  any  raw 
fruit,  unless  you  can  pare  it  or  peel  it."  Outbreaks  of  typhoid  fever, 
dysentery,  cholera,  diarrhea  and  various  other  diseases  have  often  spread 
from  disregard  of  this  warning,  and  the  consumption  of  imported  raw, 


526  SPECIAL   DIETS 

unripe  or  over-ripe  fruit  is  frequently  a  cause  of  tropical  diseases  in  tem- 
perate countries.  Nor  is  it  safe  to  eat  any  variety  of  fruit  purchased  from 
the  fruit  stands  of  our  northern  cities,  without  peeling,  as  the  fruit  vender 
often  has  the  industrious  habit  of  polishing  his  apples  with  a  rag  on  which 
he  frequently  spits.  Again  many  diseases  are  communicated  from  the 
ingestion  of  green  vegetables,  more  especially  that  class  of  diseases  pro- 
duced by  animal  parasites.  Hydatid  disease,  one  of  the  most  terrible  of 
this  type,  is  caused  by  the  Taenia  echinococcus,  a  small  tapeworm  which 
is  taken  into  the  body  in  the  form  of  ova  or  partially  developed  Taenia  on 
green  vegetables,  such  as  watercress,  celery,  lettuce,  etc.  Actinomycosis 
also  enters  the  organism  with  green  vegetables  and  cereals,  while  ergotism 
is  a  disease  common  among  consumers  of  rye  bread.  Pellagra  and  beri- 
beri are  deficiency  diseases  due  to  vegetable  foods,  which  will  be  consid- 
ered elsewhere  in  this  work.^ 

•  Tibbies  coincides  with  Hueppe's  opinion  that  the  supposed  health- 
giving  properties  of  a  strictly  vegetarian  diet  are  questionable.  ^'The  vege- 
tarians of  our  time,"  Hueppe  avers,  "belong  to  the  class  of  neurotic  men 
who,  failing  to  meet  the  strain  of  town  life,  ever  seek  for  a  'heal-all'  in 
one  or  another  crank.  Their  doctrines,  pushed  with  fanatic  zeal,  make 
no  impression  on  the  healthy,  and  only  tend  to  overthrow  the  balance  of 
others,  who,  like  themselves,  are  the  victims  of  unnatural  modes  of  exist- 
ence." WaylenCT),  himself  a  believer  in  this  cult,  and  one  who  had  inti- 
mate acquaintance  with  many  vegetarians,  in  writing  on  this  subject  says 
that  for  eight  years  he  was  a  vegetarian,  wore  sandals  and  went  without 
a  hat ;  but  it  gradually  dawned  upon  him  that  man  is  somewhat  diiferent 
from  the  beasts;  that  if  a  monkey  can  do  something,  it  does  not  follow 
that  a  man  should  do  likewise.  He  says :  "Vegetarians  as  a  rule  are  not 
healthy  folks.  They  present  either  a  wizened  and  emaciated  appearance 
or  a  tendency  to  flabbiness.  They  have  a  poor  circulation,  and  are  liable 
to  chills.  They  suffer  from  dyspepsia,  flatulence,  bad  breath  and  anemia. 
Their  liver  and  kidneys  are  commonly  affected,  and  altogether  there  is  a 
wanj;  of  vitality  among  them.  They  burden  their  stomachs  with  masses 
of  crude  stuff,  and  practically  deprive  themselves  of  fat  and  oil;  and 
while  they  daily  grow  thin  and  nervous,  they  think  they  are  improving  in 
health."  Waylen  in  summing  up  this  question  says  that  when  the  human 
body  is  starving,  it  begins  to  feed  upon  itself,  and  vegetarians  may  be 
charged  with  being  guilty  of  a  species  of  cannibalism. 

We  have  already  shown  in  "Feeding  in  Health,"  '  what  the  influence 

1  Volume  TIT,  Chapter  XVII. 

2  Chapter  X,  this  volume. 


VEGETABLE    DIET  527 

of  flesh  food  is  on  the  character  of  animals,  and  this  we  will  supplement 
by  the  opinions  of  two  celebrated  men  who  were  keen  observers  of  them- 
selves : 

Porphyre(2),  a  philosopher  who  gave  up  the  Pythagorean  doctrine 
to  eat  meat,  in  writing  to  his  friend  Firmus,  says : 

It  is  not  amongst  the  eaters  of  simple  and  vegetable  foods,  but  amongst  the 
eaters  of  flesh,  that  assassins,  tyrants  and  thieves  are  met  with.  I  cannot  believe 
that  your  change  of  diet  is  due  to  reasons  of  health,  for  you  yourself  have  con- 
stantly affirmed  that  vegetable  diet  is  much  more  suitable  than  any  other,  not 
only  to  give  perfect  health,  but  even  a  philosophic  and  balanced  judgment,  as  a 
long  experience  had  taught  you. 

And  Seneca,  who,  preoccupied  with  the  same  considerations,  had 
slowly  adopted  vegetarianism,  writes : 

Struck  by  such  arguments,  I  also  have  given  up  the  use  of  the  flesh  of  ani- 
mals, and  at  the  end  of  a  year  my  new  habits  have  become  not  only  easy  to  me, 
but  delicious;  and  it  even  seems  to  me  that  my  intellectual  aptitudes  have  been 
more  and  more  developed. 

We  learned  when  studying  foods  from  the  vegetable  kingdom  that 
green  vegetables  and  fresh  fruit  are  absolutely  necessary  to  the  well-being 
of  mankind,  but  particularly  for  the  inhabitants  of  the  cities  and  towns. 
Scurvy,  which  once  was  a  scourge,  is  now  rarely  seen,  due  largely  to  the 
fact  that  all  people  realize  the  necessity  for  adding  fresh  vegetables  and 
fruits  to  the  dietary.  As  previously  stated,  fresh  vegetables,  potatoes  and 
fruit  contain  certain  salts  which  are  absolutely  essential  to  the  proper 
constitution  of  the  blood  and  other  fluids  of  the  body.  "Tf  these  salts  are 
withheld  from  the  dietary,"  according  to  Tibbies,  "the  blood  becomes  im- 
])()verislied,  and  scurvy  results" (8).  The  necessity  for  vegetables  and 
fruit  in  the  diet,  therefore,  cannot  be  denied,  but,  at  the  same  time,  we 
must  insist  that  an  exclusive  vegetable  diet  is  inconsistent  with  the  ability 
of  man  to  live  upon  all  kinds  of  food ;  that  vegetable  foods  alone  entail  a 
laiger  amount  of  work  on  the  digestive  organs;  and  that  they  do  not  fur- 
nish sufi:cient  stimulating '  energv'  for  our  present  mode  of  civilization. 
It  is  an  admitted  fact  that  some  people  feel  better  on  a  vegetarian  diet  than 
one  containing  meat.  Plethoric  individuals  often  complain  of  physical 
hebetude  and  want  of  energy  after  a  heavy  dinner  of  hot  meat  with  the 
usual  accompaniments,  but  are  free  from  these  symptoms  after  partaking 
of  a  vegetarian  meal.  We  have  shown  in  a  previous  chapter  that  the 
wealthy  classes,  who  have  the  opportunity  and  can  afford  the  luxury,  dine 
too  often  and  partake  too  freely  of  meat  and  game,  and  as  a  consequence 
they  are  troubled  with  disorders  little  known  among  vegetarians.     How- 


528 


SPECIAL    DIETS 


ever,  a  vegetarian  diet,  as  a  rule,  is  not  more  healthy  than  a  mixed  dietary, 
nor  does  it  give  an  assurance  of  a  longer  life.  Moreover,  insnrance  statis- 
tics place  less  value  on  the  life  of  a  vegetarian  than  on  the  life  of  the  aver- 
age American  or  European  who  subsists  on  a  mixed  ration.  According  to' 
Tibbies,  there  are  large  numbers  of  people  who  live  on  a  more  or  less  vege- 
tarian diet.  ''The  peasantry  of  Ireland  subsist  upon  a  dietary  consisting 
largely  of  potatoes  with  a  little  milk,  eggs  and  pork,  occasionally  replacing 
potatoes  by  oatmeal.  This  dietary  is  also  that  of  the  poorer  classes  in 
Scotland.  The  lower  classes  of  Germany  and  Russia  live  largely  upon 
rye  bread,  potatoes  and  fat.  The  Italians  subsist  upon  cornmeal,  chest- 
nuts and  acorn  meal.  In  India  and  China  the  poor  live  largely  on  rice, 
millet  and  vegetables,  with  more  or  less  pulse  and  other  legumes." 

Wait (9),  of  the  United  States  Department  of  Agriculture,  reports  an 
investigation  of  the  dietary  consumed  by  a  subject  under  a  two  weeks' 
observation.  A  small  amount  of  meat  was  added,  as  a  seasoning  to  the 
peas,  the  digestibility  of  which  was  the  main  object  of  the  research. 


WAIT'S  VEGETARIAN  AND  FAT  DIETARY 


Ration 

Total 
Food  for 
Four  Days 

Contents  of 

Food:  Grams 

Energy, 
Calories 

Protein 

Fat 

Carbo- 
hydrates 

Ash 

Bread 

Grams 

],170 

2,600 

130 

78 

910 

130 

1,100 

total  food 
peas,  per 

112 

81 

2 

4 

11 

219 

11 
138 
116 

71 

7 

16 

679 
132 

"183 
130 
684 

11 

18 
4 
2 

7 

39 

3,600 

Milk 

2,182 

Butter 

1,048 

Pork 

670 

Bananas 

817 

Sugar 

515 

Peas 

4,299 

Total 

Paily  average 

Proportion  digested: 

per  cent 

Proportion  digested: 

cent 

429 
107 

78 

67 

359 
90 

97 

94 

1,808 
452 

94 

85 

81 
20 

64 

49 

13,131 
3,283 

88 

75 

Vegetable  versus  Animal  Protein. — In  studying  the  subject  of  protein 
and  nutrition  ( 1 ) ,  we  found  that  the  protein  of  vegetables  is  not  so  readily 
digested,  absorbed  and  assimilated  as  the  proteins  from  animal  food. 
During  the  process  of  digestion  a  much  larger  proportion  of  nitrogenous 
compounds  escapes  the  influence  of  the  digestive  ferments  and  hormones, 
principally  due  to  the  difference  in  the  solubility  of  the  connective  tissue 


VEGETABLE    DIET  529 

enveloping  the  animal  cells  and  the  cellulose  surrounding  the  vegetable 
cells.  It  is  easily  understood,  therefore,  that,  in  order  to  secure  from  a 
purely  vegetarian  dietary  the  amount  of  protein  usually  considered  neces- 
sary for  the  organism,  a  great  deal  more  labor  is  demanded  on  the  part 
of  the  digestive  organs  than  is  required  in  the  digestion  of  animal  pro- 
tein from  an  ordinary  mixed  diet.  We  have  previously  pointed  out  the 
fact  that  it  is  more  economical  to  secure  protein  from  legumes  than  from 
meat,  milk  or  eggs,  and  for  this  reason,  the  use  of  legumes  should  be  en- 
couraged where  the  diet  is  deficient  owing  to  a  limited  income. 

The  question  whether  vegetable  protein  has  the  same  physiological 
value  wlien  absorbed  as  animal  protein  is  a  debatable  one.  Vegetarians 
claim  that  vegetable  proteins  are  specifically  different  in  their  action  from 
animal  proteins.  They  go  so  far  as  to  make  the  statement  that  they  have 
a  different  effect  on  the  body,  and  also  on  the  character  and  morale.  Our 
present  knowledge  of  the  demolition  of  the  protein  molecule  is  such  as  to 
lead  us  to  question  that  any  specific  difference  exists.  Moreover,  we  do 
not  think  the  point  a  good  one  for  vegetarians  to  raise,  for  it  is  barely 
possible  that  animal  protein  requires  a  less  complete  deamination  than 
vegetable  protein  prior  to  assimilation.  We  all  know  that  the  protein 
molecule  is  composed  of  twenty  or  more  amino-acids  and  that  the  proteins 
of  animal  foods  have  been  constructed  out  of  vegetable  proteins  eaten  by 
an  animal.  Physiologists  tell  us  that  the  same  kind  or  the  same  proportion 
of  amino-acids  is  not  contained  in  all  proteins,  the  principal  difference 
being  one  of  percentage  or  proportion.  We  believe  the  consensus  of  opin- 
ion at  the  present  time  is  that  it  matters  little  whether  the  amino-acids  are 
obtained  from  the  animal  or  vegetable  foods,  that  whatever  their  source 
they  have  practically  the  same  value. 

At  best,  a  vegetable  diet  furnishes  a  low  protein  alimentation,  and  this 
deficiency  is  one  of  its  greatest  disadvantages,  especially  among  the  poorer 
classes,  in  the  case  of  growing  children,  who  are  so  much  in  need  of  a 
bountiful  supply  of  protein  to  build  up  their  tissues.  As  we  have  previ- 
ously recorded,  it  is  possible  to  maintain  the  nitrogen  balance  in  equilib- 
rium when  the  amount  of  protein  actually  absorbed  is  around  56,  58  or 
GO  grams  daily.  An  adult  can  maintain  this  equilibrium  on  a  low  protein 
diet,  but  this  cannot  be  done  in  the  case  of  a  child.  Physiologists  who 
have  given  this  subject  great  attention  claim  that  a  low  average  of  protein 
in  the  food  is  one  of  the  chief  causes  of  the  high  mortality  among  the  chil- 
dren of  the  poor(lO).  It  has  been  stated  by  competent  authority  that  "the 
protein  of  vegetables  is  not  as  valuable  from  a  nutritive  standpoint  as  the 
protein  from  animal  foods."    But  protein  is  protein,  whatever  be  its  ori- 


530  SPECIAL    DIETS 

gin;  albumin  or  globulin  is  of  the  same  nutritive  value  whether  it  be 
obtained  from  animal  or  vegetable  foods.  It  has  been  well  said  by  Tib- 
bies, however,  that  we  cannot  get  away  from  the  practical  fact  that  meat 
gives  a  greater  degree  of  energy  than  peas  or  beans.  Vegetarians  may 
den}'  this,  but  it  is  founded  on  general  experience  that  a  man  has  a  more 
buoyant  feeling  when  living  on  an  ordinary  mixed  diet  than  when  living 
on  a  strict  vegetarian  diet.  It  has  been  authoritatively  stated  that  most 
vegetarians  are  neurotics.  They  do  not  possess  the  energy,  activity  and 
endurance  of  an  ordinary  individual.  Tibbies  explains  this  as  fol- 
lows(3) : 

Given  an  equal  amount  of  protein  from  the  two  sources,  they  have  an  equal 
value  so  far  as  anybody  can  tell.  The  proteins  in  animal  foods  are  albumins  and 
globulins;  those  in  vegetables  belong  chiefly  to  the  class  of  globulins.  There  are 
nucleo-proteins  in  both  animal  and  vegetable  foods.  The  non-protein  nitrogen 
of  animal  foods  consists  chiefly  of  the  extractives,  ereatin,  ereatinin,  xanthin, 
hypoxanthin,  camin,  urea  and  uric  acid;  that  of  vegetables  is  chiefly  in  the  form 
of  amides  and  amino-aeids — leucin,  tyrosin,  asparagin,  etc.  Herein  lies  the  chief 
difference  in  the  properties  of  animal  and  vegetable  protein  foods.  The  extractives 
of  animal  foods  are  more  stimulating  than  those  of  vegetable  foods.  It  is  not  con- 
tended that  they  give  greater  bodily  strength.  Energy  is  not  to  be  confounded 
with  muscular  strength;  energy  is  the  property  of  the  nerves,  strength  of  the 
muscles.  Physical  work  is  done  by  the  muscles,  but  it  is  initiated  and  controlled 
by  the  nervous  system.  The  extractives  of  meat  are  valuable  nerve  stimulants. 
Leucin,  tyrosin,  and  other  amino-acids  of  a  like  character  are  not  stimulants,  and, 
unless  they  are  utilized  by  the  cells  of  the  intestinal  mucosa  in  the  construction 
of  proteins,  they  pass  on  to  the  liver,  where  they  are  broken  down  into  urea, 
uric  acid,  and  ammonia.  If  they  are  too  abundant  to  be  broken  down  by  the 
liver,  they  affect  the  organism  adversely  and  give  rise  to  some  of  the  symptoms 
of  intestinal  toxemia.  The  last  argument  has  been  applied  with  equal  force  to  the 
extractives  and  purin  bodies  in  meat.  But  the  display  of  energy  by  the  carnivora 
is  very  much  greater  than  that  exhibited  in  general  by  the  herbivora,  and  this  is 
accounted  for  not  only  by  the  greater  consumption  of  protein,  but  by  the  different 
character  of  the  associated  non-protein  nitrogen  compounds. 

The  question  has  been  asked,  "Has  the  character  of  the  protein  any 
influence  upon  the  development  of  organs  and  the  performance  of  their 
functions?"  This  subject  was  alluded  to  when  studying  the  section  on 
Protein  and  Nutrition(l).  The  great  importance  of  protein  in  the  ali- 
mentation cannot  be  too  strongly  emphasized.  In  a  previous  chapter,  we 
stated  that  during  the  period  of  growth  and  development  of  the  body  an 
abundance  of  protein  was  necessary.  It  is  generally  acceded  to  by  physi- 
ologists that  a  low  protein  diet  is  unsuitable  for  growing  children  and 
young  adults.     Notwithstanding  this  fact,  there  are  many  thousands  of 


VEGETABLE    PIET  531 

growing  children  in  the  East  Side  districts  of  New  York,  for  instance, 
who  subsist  on  a  diet  very  low  in  protein. .  The  question  before  us  is, 
however,  "Does  the  kind  of  protein  influence  this  period  oi  growth  ?" 
Tibbies  points  out  that  the  consumption  of  meat  in  England  at  the  present 
time  is  seventeen  times  greater  per  person  per  annum  than  it  was  in  1850. 
During  the  intervening  period  he  declares  there  has  been  a  very  marked 
decline  in  the  birth  rate.  He  also  records  that  this  decline  is  most  marked 
in  the  classes  of  society  who  have  an  unrestricted  allowance  of  the  more 
expensive  proteins  of  meat,  game,  fish  and  fowl.  In  our  own  country, 
and  especially  in  New  York  City,  the  most  fertile  families  are  the  poorest 
classes  in  the  East  Side  tenements,  whose  consumption  of  animal  protein 
is  restricted  for  economic  reasons  and  naturally  whose  proteins  are  chiefly 
derived  from  the  vegetable  kingdom.  It  has  been  pointed  out  by  some 
authorities  that  the  increasing  consumption  of  animal  foods  affects  the 
development  of  the  organs  of  generation,  "acts  prejudiciously  upon  repro- 
duction and  lactation,  and  is  thereby  an  important  factor  in  the  causation 
of  the  declining  birth  rate  and  diminishing  power  of  lactation."  This 
opinion,  it  is  claimed,  has  been  confirmed  by  experiments  on  animals (3). 
Tibbies,  in  discussing  this  subject,  says: 

The  fecundity  of  the  poor  and  comparative  sterility  of  the  rich  in  highly 
civilized  communities  is  a  matter  of  common  knowledge,  but  to  claim  that  one 
condition  is  due  to  a  vegetarian  or  low  protein  diet  and  the  other  to  animal  pro- 
teins or  a  high  protein  diet,  is  at  present  beyond  our  power  of  conception.  There 
is  in  fact  very  good  evidence  that  a  flesh  diet  does  not  diminish  fecundity  when 
the  consumers  live  a  normal  life.  The  Eskimo  women  are  not  sterile,  and  the 
Indian  women  who  subsist  largely  on  a  flesh  diet  are  fertile.  The  Boer  women 
eat  meat  at  every  meal,  new  vegetables  and  potatoes  being  seldom  seen  on  their 
tables;  nevertheless  they  are  most  prolific  and  feed  their  children  at  Nature's 
fountain. 

Summary. — By  way  of  conclusion,  we  will  summarize  the  main  points 
in  this  section  in  favor  of  and  against  vegetarianism. 

(a)  Foods  from  the  vegetable  kingdom  are  rich  in  carbohydrates  and 
poor  in  protein  and  fat.  They  are  bulky  from  their  richness  in  starch, 
from  the  presence  of  cellulose,  and  from  the  large  amount  of  water. 
(h)  The  foods  from  the  animal  kingdom  are  rich  in  protein  and  fat,  and, 
with  the  exception  of  milk,  poor  in  carbohydrates.  They  occupy  little 
bulk  in  the  raw  state,  and. even  less  after  cooking,  (c)  Foods  from  the 
vegetable  kingdom  are  less  easily  digested  and  on  the  whole  less  completely 
absorbed  than  foods  from  the  animal  kingdom ;  owing  to  their  bulkiness 
and  the  indigestible  cellulose  which  invests  their  nutritive  constituents 


532  SPECIAL  DIETS 

they  are  prone  to  fermentation  in  the  alimentary  canal,  with  the  produc- 
tion of  acids  which  tends  to  augment  peristalsis.  The  protein  constituents 
of  vegetable  foods  are  more  difficult  of  absorption  than  protein  from  ani- 
mal food,  (d)  A  strictly  vegetarian  diet  is  apt  to  be  deficient  in  protein, 
due  to  its  imperfect  absorption,  so  the  question  of  vegetarianism  becomes 
a  question  whether  it  is  advisable  to  live  on  a  low  protein  diet  or  not. 
(e)  The  strict  vegetarian,  who  subsists  entirely  upon  foods  grown  in  the 
sunlight,  must  either  live  upon  a  diet  relatively  poor  in  protein  or  else 
consume  an  excessively  large  amount  of  food.  (/)  Statistics  seem  to  em- 
phasize the  point  that  a  strict  vegetarian  aliment  tends  to  diminish  energy, 
both  mental  and  physical,  as  well  as  the  power  of  resisting  disease,  and 
if  a  vegetarian  attempts  to  consume  sufficient  food  to  yield  the  required 
amount  of  protein,  the  bulkiness  of  the  diet  is  apt  sooner  or  later  to  lead 
to  derangement  of  the  stomach  and  bowels,  (g)  Both  of  these  results 
may  be  overcome  by  supplementing  the  vegetable  part  of  the  diet  with 
animal  substance  rich  in  protein,  but  a  large  part  of  the  necessary  protein 
can  be  safely  taken  from  the  vegetable  kingdom.  (A)  Milk  and  milk 
products,  eggs,  fish  and  meat  may  be  used  as  protein  carriers,  but  for  per- 
sons in  a  normal  condition  of  health  the  moderate  use  of  meat  and  fish 
is  advantageous.  For  the  individual  of  a  gouty  diathesis,  possibly  milk 
and  cheese  are  preferable,  while  skimmed  milk  or  buttermilk  and  the 
cheaper  kinds  of  cheese  will  be  found  more  economical,  (i)  From  an 
economical  standpoint,  there  is  no  doubt  that  it  will  pay  to  patronize 
the  green  grocer  instead  of  the  butcher  in  purchasing  the  necessary  food 
elements  for  subsistence.  Vegetable  foods  can  be  purchased  to  better  ad- 
vantage both  as  sources  of  building  material  and  energy  than  animal  foods, 
so  that  vegetarianism  may  be  recommended  on  the  grounds  of  financial 
economy,  (j)  It  is  a  fact  that  vegetable  foods  are  less  highly  flavored 
and  less  appetizing  than  some  of  the  animal  foods,  but  they  have  the  ad- 
vantage of  not  being  liable  to  undergo  putrefaction  and  of  rarely  produc- 
ing disease. 

MEAT   DIET 

An  exclusive  alimentation  from  the  flesh  of  animals  is  sometimes  ac- 
cepted through  necessity.  There  are  certain  individuals  who  think  that 
meat  forms  the  most  nourishing  and  most  fortifying  food.  In  fact,  some 
men  who  are  obliged  to  live  a  very  fatiguing  life,  as  the  northern  trappers 
and  hunters,  and  the  inhabitants  of  excessively  cold  climates,  such  as  the 
fishermen  living  on  the  banks  of  the  frozen  seas,  can  subsist  almost  en- 
tirely upon  enormous  quantities  of  meat  or  fish  without  suffering  any 


MEAT    DIET  533 

untoward  effects.  Two  conditions  are,  however,  essential :  The  meat  must 
be  ingested  with  its  fat,  and  the  individuals  partaking  of  such  a  diet  must 
lead  a  very  active  life  in  the  open  air. 

There  is  no  evidence  to  lead  us  to  believe  that  the  primitive  peoples 
of  antiquity  were  vegetarians,  for  the  adaptability  of  the  human  body  to 
the  use  of  animal  foods,  as  well  as  our  earliest  historical  records,  disproves 
this;  while  some  of  the  most  savage  peoples  of  the  present  time  subsist 
almost  exclusively  on  fish  and  game.  Darwin  records  that  the  gauchos  of 
the  American  pampas  can  sustain  themselves  for  whole  months  on  the 
fat  meat  of  the  oxen  over  which  they  watch.  The  Eskimos  can  devour 
five  to  six  pounds  of  reindeer  meat  per  day  and  almost  twice  that  amount 
of  the  fat  and  flesh  of  the  seal,  concerning  which  we  have  already  made 
mention.  This  diet  of  animal  food  becomes  unbearable  if  the  meat  is 
all  lean.  Gautier  has  made  some  experiments  on  dogs  with  a  lean  meat 
diet.  A  dog  weighing  40  pounds  required  1,500  grams  of  lean  meat  as 
the  necessary  requirement  to  keep  its  weight  constant,  whereas  400  grams 
of  meat,  200  grams  of  fat  or  100  grams  of  meat,  100  grams  of  milk  and 
300  grams  of  bread  were  amply  sufficient  to  obtain  the  same  result.  The 
findings  from  this  experiment  hold  good  in  the  case  of  man.  In  order  to 
secure  the  280  grams  of  carbon  necessary  for  the  repair  of  his  organs  and 
the  discharge  of  his  functions,  1,600  grams  of  lean  meat  would  be  essen- 
tial for  the  average  man.  This  quantity  would  introduce  as  pure  waste 
four  times  more  protein  than  could  be  metabolized.  Such  enormous  quanti- 
ties of  meat  from  the  point  of  view  of  hygiene  and  economy  could  only 
lead  to  unfavorable  conditions ;  besides,  no  one  could  for  any  length  of  time 
consume  such  enormous  quantities  of  meat  without  suffering  from  symp- 
toms of  auto-intestinal  intoxication.  A  mixed  alimentation  composed  of 
a  rather  larger  percentage  of  meat  than  the  standard  requirement  permits 
of  furnishing  the  system,  in  the  least  bulk,  with  the  greatest  amount  of 
the  most  nitrogenous,  stimulating  and  useful  food  principles. 

However,  it  would  be  erroneous  to  conclude  that  an  alimentation  en- 
riched In  meat  to  the  point  of  being  exclusively  carnivorous  would  in- 
crease the  physical  power  of  the  subject.  Although  a  dietary  taken  ex- 
clusively from  the  animal  kingdom  raises  the  nitrogenous  coefficient  in 
comparison  with  a  mixed  or  vegetable  alimentation,  a  meat  diet  acidifies 
the  blood  and  hinders  oxidation.  It  overburdens  the  organs  of  excretion 
with  a  superabundance  of  nitrogenous  waste,  urea,  uric  acid,  etc. ;  it  con- 
gests the  liver;  it  causes  obstinate  constipation;  it  brings  on  dyspepsia, 
gastric  disturbances  and  enteritis;  it  induces  intestinal  putrefaction  and 
intestinal  stasis ;  it  brings  about  rheumatic,  arthritic,  gouty  and  nervous 

134 


534  SPECIAL    DIETS 

tendencies.  A  dietary  not  exclusively  meat  but  only  too  rich  in  meat 
could  not  be  borne  for  long.  According  to  Huchard,  such  a  diet  would 
produce  arterial  hypertension  and  heart  fatigue,  and  sooner  or  later  be- 
come an  active  predisposing  cause  of  arteriosclerosis.  Houssaye  has 
shown  that  in  the  case  of  fowls,  an  exclusive  meat  diet  produces  sterility 
and  causes  an  arrest  of  development  with  an  excessive  proportion  of  males. 

In  view  of  the  foregoing  facts,  then,  an  exclusive  diet  of  flesh,  or  even 
a  mixed  diet  wherein  meat  is  liberally  ingested,  is  not  looked  upon  favor- 
ably from  any  point  of  view.  A  dietary  composed  too  largely  of  meat 
tends  to  make  individuals  more  aggressive,  more  headstrong,  and  the  in- 
telligence less  keen.  The  well-to-do  classes  are  too  carnivorous.  Accord- 
ing to  Herbert  Spencer (11),  there  is  a  marked  contrast  between  the  chil- 
dren of  families  where  the  diet  is  largely  animalized  and  those  where  the 
diet  is  largely  potatoes  and  bread.  From  both  points  of  view,  that  of 
physical  and  that  of  intellectual  vivacity,  the  peasant's'  child  is  far  inferior 
to  that  of  the  gentleman.  From  the  point  of  view  of  physical  health  and. 
strength  in  actual  life,  Spencer's  dictum  does  not  appear  to  hold  good; 
as  to  the  intellectual  vivacity  of  the  child  in  the  well-to-do  classes  of  so- 
ciety, it  is  far  more  influenced  by  heredity — the  selection  of  progenitors — 
and  by  educational  advantages. 

An  exclusive  meat  diet  has  long  been  used  in  the  dietetic  treatment 
of  tuberculosis,  on  the  assumption  that  the  association  of  gout  with  high 
living  is  largely  due  to  the  free  ingestion  of  animal  food ;  that  a  gouty 
condition  can  be  artificially  brought  about  through  a  dietary  consisting 
largely  of  flesh  foods ;  and,  as  is  held  by  some,  that  there  is  an  antagonism 
between  a  gouty  diathesis  and  a  tuberculous  tendency.  The  main  object, 
therefore,  of  an  exclusive  carnivorous  diet  is  to  induce  that  condition 
which  is  believed  to  be  antagonistic  to  the  growth  of  Bacillus  tuberculosis 
or  its  toxins(l).  When  a  meat  diet  is  ordered,  the  meat  must  be  freed 
from  bone,  gristle  and  connective  tissue,  and  only  slightly  cooked.  It 
must  be  taken  in  quantities  sufficient  to  yield  energy  or  fuel  value  to  sup- 
ply the  heat  expended  by  the  body — 2,000,  2,700  calories  or  more,  depend- 
ing upon  the  condition  of  the  patient.  An  exclusive  diet  of  flesh  of  ani- 
mals, fowls  and  fish  is  also  recommended  for  obesity — setting  up  a  species 
of  starvation,  and  for  dyspeptic  ailments,  because  of  its  simplicity  and 
freedom  from  carbohydrate  fermentation. 

It  is  necessary  for  a  patient  on  a  meat  diet  to  consume  from  two  to 
two  and  a  half  pounds  of  the  edible  portion  of  average  beef  or  mutton  to 
supply  the  body  with  the  requisite  amount  of  nutriment  to  meet  the  de- 
mands of  the  organism.     One  pound  of  beef  or  mutton  freed  from  bone, 


MEAT    DIET 


535 


gristle  and  connective  tissue  equals  453  grams.  Rubner  conducted  a 
series  of  experiments  with  an  exclusive  carnivorous  diet  upon  healthy 
medical  students.  The  alimentation  consisted  of  from  738  to  884  grams 
of  the  edible  portion  of  beef.  It  was  prepared  with  a  little  butter,  onion, 
salt  and  pepper.  The  beverage  prescribed  was  water  or  aerated  water. 
After  being  cooked,  specimens  of  the  food  were  analyzed  to  determine 
the  percentage  of  protein  and  fat.  The  students'  digestion  was  normal 
in  every  particular,  the  feces  containing  only  1,2  grams  of  nitrogen  or 
about  7  grams  of  protein.  The  nitrogen  balance  was  maintained  in  a 
state  of  equilibrium  with  a  slight  gain  in  weight. 

Solntzer  conducted  experiments  with  beef  and  mutton,  and  Atwater 
experimented  with  both  l)oef  and  fish.  The  results  of  some  of  these  ex- 
periments recording  the  nitrogen  equilibrium  are  graphically  set  forth 
in  the  following  table  from  Tibbles(3)  : 

METABOLISM  WITH  MEAT  DIET 


Food  per  Diem 

Days 

Nitrogen 

.      Au- 

Grams 

Grams 

Grams 

Gain  or 

thority 

in  Food 

in  Urine 

in  Feces 

Loss 

Beef,  884  grams 

3 

48.8 

47.2 

1.2 

0.4  \ 
1.1/ 

1.7] 
27.4 

«     738      "     

3 

39.8 
31.9 
90.9 

37.6 
25.6 
58.5 

1.1 
4.6 
5.0 

Rubner 

«     715      "     

Mutton,  1,671  grams 

1,336      "     

56.4 

50.5 

3.9 

2.0  \ 

Solntzer 

Canned  beef,  895  grams..  . . 

43.9 

27.8 

7.5 

8.6 

"      mutton,  1643  grams . 

75.2 

65.3 

8.6 

1.3  J 

Beef  1,200,  butter  30.  wine 

367,  beer  1,250  grams..  . . 

3 

38.5 

37.2 

1.0 

0.31 

Fish  1,549,  butter  50,  wine 

. 

Atwater 

700,  beer  1,250  grams..  . . 

3 

45.6 

44.1 

0.9 

0.6  J 

The  value  of  an  exclusive  meat  diet  in  the  treatment  of  tuberculosis, 
obesity,  dyspepsia,  and  gout  has  already  been  pointed  out,  and  will  be 
further  elaborated  upon  when  these  different  ailments  are  discussed. 
It  also  has  been  recommended  in  chronic  dyspepsia,  especially  in  a 
condition  of  atony  and  in  dilatation  of  the  stomach,  and  its  value 
is  unquestioned  in  hyperchlorhydria.  The  fact  must  not  be  lost  sight  of, 
however,  that  sufficient  nutriment  must  be  consumed  to  meet  the  demand 
of  the  body,  which  will  require  from  two  to  three  pounds  of  the  edible 
portion  daily.  The  qiuintity  of  moat  sliould  never  he  less  than  six  ounces 
of  thoroughly  minced  meat,  slightly  cooked,  ingested  at  least  three  times 
per  day,  the  intervals  being  from  4V^  to  5  hours. 


636  SPECIAL    DIETS 

Salisbury  Diet. — The  Salisbury  diet  (12)  is  a  typical  meat  diet  con- 
sisting of  from  2  to  4  pounds  of  beef  and  3  to  5  pints  of  hot  water  daily 
for  from  4  to  12  weeks.  It  has  been  recommended  as  a  means  of  treating 
certain  diseases  of  the  skin,  as  psoriasis  (13),  which  have  resisted  the  usual 
forms  of  medication. 

It  is  also  recommended  by  Dr.  Salisbury  for  the  dietetic  treatment  of 
gout,  obesity,  chronic  intestinal  derangements,  and  disorders  of  nutrition 
which  are  attributed  to  abnormal  carbohydrate  fermentation.  The  treat- 
ment aims  at  the  thorough  cleansing  of  the  stomach  before  eating,  by  giv- 
ing a  pint  of  hot  water  an  hour  and  a  half  before  each  meal  and  at  bed- 
time. If  the  water  is  drunk  slowly,  the  patient  will  not  experience  any 
sense  of  discomfort  nor  will  the  stomach  become  distended.  The  slightly 
nauseating  taste  of  plain  hot  water  may  be  overcome  by  the  addition  of 
ginger,  lemon  juice  or  vreak  tea,  and  in  cases  where  intense  thirst  is  pres- 
ent, the  addition  of  a  little  nitrate  of  potash  makes  the  water  a  more  effi- 
cient thirst  quencher.  If  constipation  is  present,  a  teaspoonful  of  mag- 
nesium sulphate  may  be  added  to  the  water.  The  urine  should  be  exam- 
ined frequently  to  obtain  the  specific  gravity,  and  the  amount  of  water 
should  be  regulated  accordingly.  If  the  specific  gravity  falls  below  1.010, 
the  patient  may  become  asthenic  and  the  amount  of  water  may  be  con- 
siderably reduced.  The  specific  gravity  of  the  urine  should  be  kept  be- 
tween 1.012  and  1.015. 

Caultey(14)  gives  the  following  directions  for  the  preparation  of  the 
Salisbury  diet:  ''The  meat  is  chopped  up  quite  fine  with  an  American 
chopper,  and  all  gristle,  bone,  fat  and  visible  connective  tissue  are  re- 
moved. It  is  made  into  patties,  sufficiently  firm  to  hold  together,  three 
to  stand  near  it  until  of  a  drab  color.  Salisbury  recommends  that  they 
in  a  frying  pan,  without  fat  or  water,  and  rapidly  heated,  first  on  one 
side  and  then  on  the  other.  On  removal  from  the  fire  they  are  allowed 
to  stand  near  it  until  of  a  drab  color.  Salisbury  recommends  that  they 
should  be  broiled  slov/ly  and  moderately  well.  Butter,  pepper,  salt, 
Worcestershire  sauce,  mustard,  horseradish,  celery  salt  and  lemon  juice 
may  be  added  as  condiments.  Advocates  of  this  diet  have  recommended 
three  pounds  of  rump  steak  and  one  of  codfish,  with  six  pints  of  hot  water 
daily,  for  two  weeks.  For  the  next  three  weeks  the  hot  water  is  reduced 
to  four  pints,  and  other  kinds  of  meat  are  allowed,  with  a  little  green  vege- 
table and  unsweetened  rusks.  During -the  next  four  weeks  the  hot  water  is 
further  reduced  to  two  pints ;  hock  and  claret  with  seltzer  are  permitted, 
as  are  grilled  meat,  poultry  or  game,  crusts  of  stale  bread  and  captains' 
biscuits.    The  meat  must  not  be  raw  and  must  be  quite  fresh. 


MEAT    DIET  537 

"The  hot  water  should  be  given  in  doses  of  one-half  to  one  pint,  four  or 
more  times  a  day,  say  at  0  and  11  a.m.,  and  4  and  9  p.m.,  one  or  two  hours 
before  meals  and  half  an  hour  before  retiring.  It  should  be  of  a  tempera- 
ture of  110°  F.  to  150°  F.  and  should  be  sipped  slowly  in  one-fourth  to 
one-half  hour." 

There  are  obvious  objections  to  this  diet.  It  is  absolutely  unphysio- 
logical,  being  a  starvation  diet  in  respect  of  fat  and  carbohydrates.  The 
quantity  is  much  too  large  for  most  people.  It  throws  a  great  strain  on  the 
organs  which  have  to  do  with  the  metabolism  of  protein,  as  well  as  on  the 
organs  of  excretion.  It  is  essential  to  be  sure  that  the  kidneys  are  sound 
before  adopting  this  treatment. 

Oysters  are  a  welcome  addition  to  the  monotony  of  a  meat  diet  and 
may  be  prepared  as  follows  (15)  : 

Panned  Oysters: 

Take  6  deep-sea  oysters,  place  them  in  a  colander,  and  pour  cold  water  over 
them.  Drain  for  ten  minutes.  Place  the  oysters  in  a  very  hot  iron  pan,  add  salt, 
pepper,  a  small  piece  of  butter,  and  a  teaspoonful  of  meat  stock.  Cook  for  a  few 
minutes,  and  serve  the  oysters  garnished  with  a  thin  slice  of  lemon. 

Broiled  Oysters: 

Take  6  large  oysters.  Lay  them  on  a  board  and  dry,  then  season  with  salt  and 
cayenne  pepper.  Have  a  gridiron  thoroughly  heated,  place  the  oysters  on  the 
gridiron  and  brown  them  on  both  sides.  Place  the  oysters  on  a  very  warm  plate, 
and  pour  round  them  a  little  heated  beef  juice  and  a  little  melted  butter, 

Watson(15)  considers  the  Salisbury  diet  seldom  necessary  or  advis- 
able, but  he  recommends  a  modified  Salisbury  dietary  as  of  great  value 
in  some  cases  of  indigestion  and  chronic  auto-intoxication  associated  with 
it.  His  modification  of  the  Salisbury  diet  given  below,  while  rather  low 
in  nitrogenous  material,  is  amply  sufficient  for  the  short  period  of  time 
in  which  the  diet  is  necessary.  Its  use  exerts  a  profound  improvement 
in  the  state  of  intestinal  excretions  and  a  corresponding  improvement  in 
the  digestion  as  a  whole. 

MODIFIED  SALISBURY  DIET 
7  A.M.: 

}/2  pint  or  more  hot  water. 

Breakfast,  8.30  a.m.: 

4  to  6  oz.  meat  rissoles;  2  Kalari  biscuits  with  a  little  butter;  small  cup  of  very 
weak  lea. 

Forenoon  Lunch,  11.30  a.m.:  • 

K  pint  or  more  of  hot  water,  flavored  with  lemon  if  desired. 


538  SPECIAL    DIETS 

Dinner,  1  p.m.: 

Breakfastcupful  of  beef  tea  with  }4  lb.  scraped  meat;  thin  slice  of  baked  bread 
or  dinner  toast;    half  a  dozen  oysters  as  above;    consomm6  with  custard  or 
consomm^  with  egg,  with  baked  bread  or  toast. 
3  P.M.: 

}/2  pint  or  more  of  hot  water. 

Afternoon  Lunch,  4  p.m.  : 

Breakfastcup  of  skimmed  milk,  to  which  is  added  a  full  tablespoonful  of  Gamine 
Lefranc  or  other  meat  juice;  or  plain  egg  flip  flavored  with  cinnamon  in  place 
of  sugar;  unsweetened  rusk  or  crisp  biscuits. 
6  P.M.: 

}/2  pint  hot  water. 

Supper,  7.30  p.m.  : 

4  to  6  oz.  meat  rissoles  or  mince,  followed  by  an  egg  jelly  in  which  the  sugar  is 
reduced  in  amoimt;  or  a  blanc  mange  made  with  milk  in  place  of  cream. 

The  above  alimentation  should  be  maintained  for  ten  days  to  a  fort- 
night, after  w^hich  additions  in  the  form  of  steamed  fish,  chicken,  green 
vegetables,  malted  breads,  jellies  and  fruit  may  be  allowed.  The  return 
to  ordinary  carbohydrate  foods  must  be  made  gradually. 

Zymotherapy — Zymotherapy  is  the  name  given  to  the  treatment  of 
disease  by  the  administration  of  muscle  juice  or  raw  meat.  This  method 
of  treatment  is  in  contradistinction  to  the  meat  or  Salisbury  diet  just  de- 
scribed, which  includes  the  entire  edible  portion  of  the  meat.  The  raw 
meat  diet  is  an  ancient  remedy ;  in  recent  times  it  was  first  recommended 
for  phthisis,  empyema  and  pyogenic  infections  by  Fuster  of  Montpellier, 
in  1865.  Richet  and  Hericourt(16),  in  a  series  of  experiments  carried 
out  in  1889  on  tuberculous  dogs,  determined  the  value  of  raw  meat  and 
subsequently  showed  that  the  benefit  was  derived  from  the  muscle  juice 
and  not  from  the  muscle  fiber  deprived  of  its  juice  by  expression.  They 
reported  that  this  method  of  feeding  is  not  a  matter  of  hyperalimentation, 
for  only  50  to  100  c.c.  of  the  muscle  juice  is  suggested  as  the  daily  dosage 
which  was  sufficient  to  cure  the  dogs,  whereas  hyperalimentation  with  the 
washed  muscle  fibers  exerted  no  beneficial  effects.  The  juice  contained 
2y2  per  cent  of  protein.  "Its  administration  produces  an  increase  of  vigor 
and  muscular  power,  the  proportion  of  hemoglobin  is  increased,  blood 
pressure  is  raised,  digestion  is  improved,  weight  is  increased,  and  the 
physical  signs  of  phthisis  pulmonalis  or  tuberculosis  are  abated." 

If  we  accept  the  theory  that  tuberculosis  is  due  to  an  infection  in  early 
life  through  tuberculous  cow's  milk,  it  is  reasonable  then  to  assume  that 
undercooked  or  raw  meat  should  enter  largely  into  the  diet  of  young  chil- 
dren.   Meat  juice  and  raw  meat  are  prescribed  in  anemia,  dyspepsia,  neu- 


MEAT    DIET  539 

rasthenia,  debility,  convalescence  from  typhoid  fever,  and  after  hemor- 
rhage. 

Hericourt,  following  the  publication  of  his  initial  observations  (17) 
on  the  value  of  raw  meat  juice  in  tuberculous  dogs,  recently  published 
another  paper  on  the  subject,  from  which  we  quote  the  following:  "It  is 
probably  no  exaggeration  to  say  that  the  raw  meat  treatment  in  pulmonary 
phthisis  yields  results  not  approached  by  any  other  means  at  present 
available."  Kichet  coincides  with  his  associate's  observations,  and  to- 
gether they  undertook  researches  to  determine  which  constituent  in  the 
muscular  tissue  possesses  antagonism  to  the  progress  of  tuberculosis. 
After  much  experimentation  they  came  to  the  conclusion  that  the  solid 
constituents  of  the  flesh  had  no  therapeutic  action ;  "tuberculized  animals 
fed  on  flesh  from  which  the  muscle  plasma  had  been  expressed,  died  in 
approximately  the  same  lapse  of  time  as  the  control  animals  who  were  fed 
with  ordinary  food.  The  deduction  drawn  from  the  above  experiment 
is  that  the  agent  of  raw  meat  which  produces  this  effect  is  contained  in  the 
muscle  plasma,  i.e.,  the  meat  juice." 

The  muscle  or  meat  juice  must  be  prepared  from  perfectly  fresh  meat, 
soon  after  the  animal  dies  and  before  rigor  mortis  has  set  in ;  the  muscle 
that  has  undergone  rigor  mortis  loses  its  glycogen  and  contains  lactic  acid 
and  more  or  less  toxic  products  of  decomposition.  Hence  the  juice  should 
be  prepared  as  soon  after  death  as  possible.  If  meat  or  muscle  juice  is 
prepared  from  commercial  or  cold  storage  meat,  it  is  less  beneficial,  more 
toxic  and  possibly  infective.  The  animal  whose  muscle  is  to  be  used 
should  neither  be  overworked  nor  underfed  before  death. 

According  to  Caultey(14) :  "The  meat  must  be  finely  minced,  wrapped 
in  stout  linen,  put  in  a  sieve,  and  subjected  to  slow  pressure.  Small  house- 
hold presses  will  yield  about  20  and  larger  presses  30  to  60  per  cent  of 
juice.  If  one-fourth  the  weight  of  sterilized  water  is  added  and  the  meat 
allowed  to  stand  for  an  hour  or  two  before  compression,  more  fluid  is  ob- 
tained, but  the  bulk  and  the  increased  decomposition  are  disadvantages. 
Presses,  mincer  and  linen  should  be  well  boiled  or  washed  in  boiling  water 
before  use.  In  hot  weather  the  juice  should  be  collected  in  a  vessel  sur- 
rounded by  ice.  Even  in  winter  the  juice  should  be  taken  at  once,  because 
of  its  liability  to  decomposition.  As  it  is  repulsive  to  the  patient,  it  should 
be  given  in  a  colored  glass  or  with  warm  beef  tea.  Intestinal  disorders 
are  due  to  neglect  of  some  detail  in  the  technique,  generally  to  the  impos- 
sibility of  getting  the  meat  sufiiciently  fresh,  and  unless  great  care  is  exer- 
cised, it  is  liable  to  set  up  alimentary,  hepatic  or  renal  troubles. 

"The  dose  should  be  9  to  15  ounces  daily,  with  or  between  meals,  in 


540  SPECIAL   DIETS 

water,  aerated  water,  or  tepid  beef  tea,  with  or  without  salt  or  sugar. 
Three  to  six  ounces  is  sufficient  for  early  cases.  If  raw  meat  is  given,  as 
much  as  a  pound  a  day  can  be  ordered,  but  few  patients  can  take  more 
than  one-fourth  to  one-half  pound.  Raw  meat  and  muscle  juice  can  be 
combined  in  the  dietary.    No  cooked  meat  should  be  allowed. 

"Possibly  the  muscle  juice  contains  a  substance  which  is  antagonistic 
to  the  tubercle  bacillus  and  its  toxin,  for  muscle  fibers  are  not  invaded  by 
the  organism,  and  during  the  course  of  the  disease  they  waste,  perhaps 
being  sacrificed  in  the  defense  of  the  body.  More  probably  the  good 
effects  depend  on  the  nutritive  value  of  the  fluid  as  a  stimulant  of  the 
nervous  system  or  of  thyroid  activity." 

According  to  Galeotti  and  Lindermann,  raw  meat  and  milk  stimulate 
thyroid  activity  and  they  also  are  of  the  opinion  that  the  decomposition 
products  of  raw  meat  increase  the  colloid  material  of  the  thyroid.  It  is 
known  that  defective  thyroid  activity  and  predisposition  to  tuberculous 
affections  are  apt  to  follow  rapid  growth  at  puberty,  infectious  diseases, 
prolonged  lactation,  sexual  excess  and  alcoholism,  in  all  of  which  the  thy- 
roid secretion  is  liable  to  be  used  up  and  the  gland  to  atrophy  from  over- 
stimulation. It  is  believed  that  human  milk  contains  some  of  the  internal 
secretion  of  the  thyroid  gland,  for  iodin  can  reach  the  infant  through  the 
breast  milk.  Infantile  myxedema  is  rarely  observed  until  after  weaning, 
and  moreover  the  infant's  thyroid  gland  contains  little  colloid  material. 

Caultey,  in  summing  up  the  advantages  of  zymotherapy,  says:  "Im- 
provement in  a  tuberculous  patient  fed  on  raw  meat  and  muscle 
juice  is  noticed,  (a)  by  increased  muscular  power,  (h)  by  the  increased 
hemoglobin,  (c)  by  rise  of  blood  pressure,  and  (d)  by  better  diges- 
tion and  improvement  in  the  physical  signs.  In  the  very  young  the 
prognosis  varies  according  to  the  loss  or  gain  in  weight,  especially  during 
the  first  month.  The  treatment  should  be  continued  for  a  varying  period 
depending  upon  the  extent  of  the  disease  and  the  improvement  following 
its  administration.  It  may  be  resumed  at  intervals  depending  on  the 
condition  of  health. 

FRUIT    DIET 

The  fruitarian  diet  is  an  aliment  composed  exclusively  of  fruits  and 
nuts.  Of  late  years  many  experiments  in  metabolism  have  shown  that  it 
is  possible  for  individuals  to  maintain  a  nitrogen  equilibrium  on  such  a 
diet.     M.  E.  Jaffa*  has  thoroughly  investigated  the  fruitarians  in  Cali- 


1  Professor  of  Nutrition,  Univ.  of  California.    Bui.  132,  U.  S.  Dept.  of  Agric. 


FKUIT    DIET  541 

fornia.  His  reports  are  interesting  and  valuable,  and  from  them  we  have 
drawn  largely  in  preparing  this  section. 

It  is  not  questioned  that  an  alimentation  composed  of  fruits  and  nuts 
is  pleasant  and  agreeable.  At  the  same  time,  it  is,  at  best,  only  a  low  pro- 
tein diet,  rarely  containing  more  than  50  to  60  grams  of  protein.  It  is 
unnecessary  to  refer  to  the  arguments  for  and  against  a  low  protein 
dietary,  as  this  subject  has  already  been  fully  considered.  Chittenden  and 
other  physiologists  have  found  50  to  60  grams  of  protein  in  the  daily  food 
sufficient  for  physiological  needs,  and  many  people  have  maintained  their 
health  and  vigor  for  years  on  a  fruit  and  nut  or  other  low  protein  aliment, 
yet  they  seldom  look  rugged  or  robust.  The  fruit  and  nut  diet,  like  the 
more  common  vegetarian  diet,  must  be  considered  of  questionable  value 
and  unlikely  to  become  popular  as  a  regular  method  of  feeding,  with  peo- 
ple who  have  an  inborn  taste  and  desire  for  animal  foods. 

We  have  already  shown  that,  as  compared  with  the  so-called  standard 
dietaries,  the  vegetarian  and  fruitarian  are  lamentably  poor  in  protein 
and  fat,  and  in  some  instances  deficient  in  caloric  value.  See  also  the  fol- 
lowing tables  abstracted  from  the  excellent  study  of  Fruitarianism  by 
Professor  Jaffa (8).  Below  are  appended  the  records  (taken  from  Voit 
and  Alba)  of  three  subjects  who  subsisted  on  fruits,  as  recorded  by 
Tibbies: 

Man,  twenty-eight  years  old;  height,  5  feet  5  inches;  weight,  125  pounds. 
His  daily  diet  consisted  of:  rye  bread  (pumpernickel),  131  grams  {-i^^  ounces); 
graham  bread,  438  grams  (nearly  1  pound) ;  apples,  777  grams  (1%  pounds) ; 
dried  figs,  114  grams  (4  pounds) ;  dried  dates,  247  grams  (8  ounces) ;  oranges, 
66  grams  (2  ounces);  olive  oil,  21  grams  (Yi  ounce).  It  contained:  protein,  54 
grams;  fat,  22  grams;  carbohydrates,  573  grams;  and  had  a  heat  value  of  2,775 
calories.     (Voit's  observation.) 

Min,  forty-eight  years  old;  height,  5  feet  8  inches;  weight,  153  pounds.  He 
consumed  daily:  potatoes,  1,000  grams  (21/4  pounds);  hazel  nuts,  166  grams  (6 
ounces) ;  peanuts,  12.5  grams  {V2  ounce) ;  plums,  83  grams  (3  ounces) ;  sugar, 
71  grams  (21/2  ounces) ;  raisins,  93  grams  (31/2  ounces) ;  apples,  354  grams  (% 
pound);  oranges,  63  grams  (21/2  ounces);  oUve  oil,  50  grams  (1%  ounces).  It 
contained :  protein,  63  grams ;  fat,  66  grams ;  carbohydrates,  593  grams ;  and  had 
a  fuel  value  of  3,302  calories.     (Alba's  observation.) 

The  following  example  of  a  moderate  vegetarian  diet  is  outlined  by 
Jaffa.  His  subject  was  a  man,  aged  sixty-four  years,  height  5  feet  8 
inches,  weight  136  pounds;  he  had  been  a  vegetarian  for  eleven  years. 
The  total  food  consumed  by  him  during  a  period  of  twenty-four  days  was 
as  follows: 


542 


SPECIAL   DIETS 
JAFFA'S  VEGETARIAN  DIETARY 


Cereals: 

Granose. .  . . 

Gluten  flour . 

Flaked  rice . 

Honey 

Vegetables: 

Baked  beans 
Dried  fruits: 

Dates 

Figs 

Prunes 

Raisins 


2,155 

grams 

454 

« 

1,673 

« 

1,985 

a 

1,021 

« 

425 

« 

28 

u 

794 

u 

255 

u 

^ams 

8,790 

Carried  forward 
Fresh  fruit: 

Apples 

Bananas 

Grapes 

Raspberries 

Nuts: 

Almonds 

Brazil  nuts 

Pine-nuts 

Walnuts 

Total 


8,790  grams 

5,585  « 

2,722  " 

3,317  « 

397  « 

907  " 

1,361  « 

198  « 

907  « 


24,184  grams 


These  items  furnished  an  average  weight  of  2^4  pounds  of  food  daily 
at  a  cost  of  I8I/2  cents,  containing:  protein,  53.5  grams;  fat,  76.9  grams; 
sugar  and  starch,  301.8  grams;  crude  fiber,  10  grams.  The  fuel  value 
was  2,043  calories.  The  man  was  healthj  and  well,  and  lived  on  a  dietary 
containing  50  to  60  grams  of  protein,  or  about  half  the  amount  commonly 
accepted  as  being  necessary  for  a  man  having  a  sedentary  occupation. 

It  is  unquestioned  that  a  fruit  diet  in  certain  diseased  conditions  is  a 
valuable  trophotherapeutic  measure.  The  subject  of  Professor  Jaffa's 
investigation  was  a  healthy,  vigorous  university  student,  aged  twenty-two, 
well  set  vip,  and  prominent  in  athletic  sports. 

For  the  first  week  he  ate  his  ordinary  mixed  food;  the  next  nine  days  he  con- 
sumed a  diet  in  which  fruit  replaced  a  large  proportion  of  the  meat,  eggs,  fish, 
milk  and  cereals;  finally  he  consumed  for  eight  days  a  diet  consisting  entirely  of 
fruit  and  nuts. 

An  examination  of  the  urine  and  feces  of  other  consumers  showed  that  in 
many  instances,  although  the  diet  was  of  a  low  protein  character,  the  amount  of 
protein  digested  and  absorbed  from  the  food  was  enough  to  maintain  the  nitrogen 
balance  in  equilibrium  during  the  experiment.  When  the  amount  consumed  daily 
consisted  of  5^2  pounds  of  grapes,  6  ounces  of  walnuts,  and  a  little  granose,  there 
was  an  actual  gain  of  1.29  grams  of  nitrogen,  equal  to  8  grams  of  protein.  In 
another  instance  the  average  daily  consumption  consisted  of  414  pounds  of  apples, 
8  ounces  of  dried  figs,  and  4%  ounces  of  walnuts,  which  also  resulted  in  a  gain 
of  1.28  grams  of  nitrogen,  or  8  grams  of  protein.  With  a  diet  averaging  3V2 
pounds  of  apples,  9^  ounces  of  dates,  6  ounces  of  peanuts,  a  little  granose,  milk, 
olive  oil,  and  tomato,  the  gain  of  nitrogen  was  2.26  grams,  equal  to  14.13  grams 
of  protein.  With  5^/^  pounds  of  pears,  7  ounces  of  walnuts,  a  little  granose  and 
milk,  there  was  a  gain  of  4.25  grams  of  nitrogen,  equivalent  to  26.5  grams  of 
protein;  and  with  a  diet  averaging  16  ounces  of  walnuts,  I8V2  ounces  of  dried 
prunes,  and  18  ounces  of  oranges,  there  was  a  gain  of  3.42  grams  of  nitrogen,  or 
21.38  grams  of  protein. 


FRUIT    DIET  543 

The  experiments  in  feeding  with  hananas  did  not  give  such  good  results. 
Bananas,  dates,  and  walnuts  resulted  in  a  loss  of  1.82  grams  of  nitrogen,  or  11.38 
grams  of  protein;  bananas,  oranges  and  walnuts  gave  a  deficiency  of  1.89  grams 
of  nitrogen,  or  11.8  grams  of  protein.  The  consumption  of  5  pounds  of  bananas 
a  day  resulted  in  a  loss  of  1.34  grams  of  nitrogen,  or  8.38  grams  of  protein; 
4  pounds  of  bananas  and  AYt  ounces  of  almonds  daily  gave  a  deficiency  of  0.86 
graujs  of  nitrogen,  or  5.38  grams  of  protein;  2\<>  pounds  of  bananas,  21  ounces 
of  oranges  and  5  ounces  of  pecan  nuts  gave  a  deficiency  of  1.69  grams  of  nitro- 
gen, or  10.56  grams  of  protein.  A  diet  of  22  ounces  of  dates,  2%  ounces  of 
almonds  and  12  ounces  of  olives  gave  a  deficiency  of  2.06  grams  of  nitrogen,  or 
12.88  grams  of  protein.  A  diet  of  pears  and  cocoanut  gave  a  loss  of  1.57  grams 
of  nitrogen  and  8.8  grams  of  protein.  The  deficiency  is  not  great  in  any  of  these 
cases,  but  the  continued  daily  loss  of  1  or  2  grams  of  nitrogen  by  the  body  is 
deleterious  and  must  ultimately  result  in  ill  health.  It  is  possible,  as  we  have 
seen,  to  prevent  such  a  loss  by  means  of  a  carefully  regulated  diet;  but  it  is 
difficult  for  the  non-scientific  subject  to  adjust  his  diet  so  carefully  to  the  needs 
of  the  body.  In  this  respect,  therefore,  we  are  bound  to  state  that  very  few 
fruitarian  diets  contain  enough  protein  to  maintain  the  nitrogen  balance  in  equi- 
librium, and  still  fewer  contain  the  amount  of  protein  required  by  the  standards 
set  up  by  numerous  authorities.  The  amount  of  fat  in  the  food  is  also  almost 
always  below  the  standard  required,  and  only  reaches  the  standard  when  the  food 
contains  a  large  proportion  of  nuts,  olives  or  olive  oil.  The  nutriment  in  fruit 
consists  chiefly  of  carbohydrates,  the  digestibility  of  which  compares  very  favor- 
ably with  the  carbohydrates  in  a  mixed  diet.  Respecting  the  heat  value  of  the 
food,  the  following  table  shows  that  the  amount  of  energy  yielded  by  the  food 
is  greater  in  proportion  to  the  amount  of  fat;  it  is  low  with  bananas,  but  better 
when  bananas  and  nuts  are  consumed  together;  it  is  also  low  with  apples,  pears 
or  grapes  as  a  diet,  but  is  considerably  improved  by  the  consumption  of  half  a 
])ound  of  brazil  nuts,  pecans  or  walnuts.  A  diet  of  apples,  figs  and  walnuts,  or 
of  pears,  figs  and  walnuts,  is  capable  of  supplying  enough  protein,  fat  and  carbo- 
hydrate for  the  use  of  the  body,  and  sufficient  energy  for  a  man  doing  moderate 
work. 

Carefully  recorded  studies  of  persons  subsisting  upon  fruits  and  nuts 
are  scarce;  therefore,  the  observations  of  Jaffa (18)  are  of  special  interest. 
The  instructive  table  on  page  544  contains  a  summary  of  the  food  elements 
contained  in  the  dietary  which  each  individual,  described  by  Jaffa,  ate. 

The  first  six  of  these  people  lived  on  apples,  dates,  figs,  peaches,  apri- 
cots, bananas,  grapes,  oranges,  pears,  plums,  raisins,  olives,  almonds,  pig- 
nolia,  pine  nuts,  brazil  nuts,  walnuts,  sometimes  tomatoes,  celery  and 
honey. 

The  individuals  comprising  tbe  subjects  for  Jaffa's  studies  were  all 
vigorous  and  healthy  people.  The  six-year-old  girl  had  subsisted  on  a  fruit 
diet  since  infancy.  She  was  undersized,  but  this  may  have  been  from  in- 
heritance.   During  the  ten  days  that  she  was  under  obsen'ation  she  gained 


544 


SPECIAL   DIETS 
FRUITARIANS  STUDIED  BY  JAFFA 


Age  in 
Years 

Weight 

in 
Pounds 

Protein: 
Grams 

Fat: 
Grams 

Carbo- 
hydrate : 
Grams 

Crude 
Fiber: 
Grams 

33 

90 

33 

59 

110 

40 

30 

104 

25 

57- 

72 

27 

13 

75.5 

26 

52 

111 

46 

9 

43 

27 

56 

102 

50 

6 

30.5 

24 

58 

97 

37 

7 

34 

40 

72 

126 

8 

63 

124 

40.3 

53.7 

286.3 

24.6 

64 

136 

53.5 

76.9 

301.8 

10 

10 

58 

48.4 

67.7 

246.7 

13.4 

8 

37 

32.3 

81.7 

155 

10.7 

34 

93.5 

42.5 

81.1 

156.8 

9.8 

22 

170 

85 

158.7 

366.3 

25 

152 

68 

103 

550.1 

64.7 

48 

153 

63 

98 

401 

28 

125 

54 

22 

573 

•  .    .   . 

64 

136 

54 

77 

312 

Calories 


Woman 
Woman 
Girl. . . . 
Boy..  . . 
Girl.... 
Girl. . . . 
Man.  . . 
Woman. 
Boy.... 
Girl. . . . 
Woman 
Man.  . . 
Man.  . . 
Man.  . . 
Man.  . . 
Man.  . . 


1,300 
1,040 
1,235 
1,255 
1,190 
1,385 
1,713 
2,043 
1,729 
1,403 
1,432 
2,936 
3,305 
2,493 
2,775 
2,004 


a  pound,  and  her  brother,  aged  nine,  gained  a  pound  in  a  period  of  twenty- 
two  days.  The  thoroughness  of  digestion  and  absorption  was  comparable 
with  that  of  an  adult  on  a  mixed  diet,  80  per  cent  of  the  fibrous  cellulose 
being  completely  digested.  The  fourth  study  of  this  table  was  a  boy  aged 
nine,  who  first  subsisted  on  bananas,  oranges  and  pecan  nuts.  This  same 
boy  was  studied  a  few  months  later,  and  during  the  observation  he  sub- 
sisted on  pears  and  walnuts,  granose  and  milk.  Some  of  the  other  persons 
in  this  study  ate  cereals  to  a  limited  extent.  The  twelfth  individual  sub- 
sisted on  grapes,  brazil  nuts,  tomatoes,  granose  and  olive  oil.  He  was 
not  accustomed  to  a  fruitarian  diet,  but  tried  it  at  the  time  of  the  experi- 
ment. A  striking  feature  of  these  fruitarian  dietaries  is  the  small  amount 
of  protein  and  the  low  caloric  value  of  the  diets.  However,  they  approach 
very  closely  to  whajj  Chittenden  has  shown  is  all  that  is  needed  to  maintain 
health  and  strength. 

Fruit  Diet  in  Disease. — The  value  of  a  fruit  diet  Is  especially  marked 
when  employed  as  a  temporary  measure  in  those  instances  of  illness  or 
poor  health  in  which  the  protein  intake  must  be  diminished,  particularly 
when  the  necessity  arises  for  cutting  do"vvn  the  purin  bodies  to  the  lowest 
possible  point.  When  the  ordinary  diet  is  confined  to  fruits  and  nuts,  the 
latter  should  be  ground  in  a  mill,  mastication  should  be  thorough,  only 
a  moderate  quantity  of  food  should  be  allowed,  and  the  daily  meals  should 


FEUIT    DIET  545 

not  exceed  three.  The  best  subjects  for  the  ''fruit  cure"  are  those  who 
habitually  overindulge  in  food  and  drink,*  and  whose  systems  become 
choked  with  the  "clinkers"  of  imperfectly  oxidized  food.  Symptoms  com- 
monly complained  of  in  this  condition  are  a  foul  tasting  mouth  after  the 
night's  sleep,  early  morning  headache  and  lassitude.  This  cure  is  often 
useful  in  intestinal  fermentation  and  putrefaction ;  in  albuminuria,  gout, 
obesity,  hemicrania,  and  other  disturbances  common  to  individuals  and 
families  originally  accustomed  to  plain  and  wholesome  country  living. 
The  attempt  of  an  organism  with  such  a  background  to  adapt  itself  to  the 
modern  demands  of  city  life,  often  results  in  disaster  to  the  bodily  mech- 
anism. The  "fruit  cure"  in  such  instances  is  often  beneficial.  The  low 
protein  intake  allows  an  increased  alkalinity  of  the  blood  and  decreased 
acidity  of  the  urine;  in  addition,  its  action  is  laxative  and  diuretic,  and 
the  liver  cells  are  stimulated  to  greater  activity,  and  hinders  intestinal 
fermentation.  In  the  dietetic  treatment  of  acute  nephritis,  fruits,  such 
as  oranges,  raisins,  pears,  etc.,  will  augment  the  carbohydrates  of  the 
milk.  This  mixed  treatment  of  milk  and  fruits  diminishes  the 
albuminuria,  encourages  diuresis,  and  drives  away  edema.  If  a  pa- 
tient has  lost  weight,  raisins  or  raisin  juice,  added  to  a  diet  rich  in 
fat  and  albumin,  will  help  to  regain  the  loss.  If,  on  the  other  hand,  it 
is  thought  wise  to  decrease  the  patient's  weight,  increase  the  raisins  and 
decrease  the  fats  and  albuminoids,  other  fruits  and  vegetables  being  par- 
taken of  at  the  same  time.  The  fruit  diet  is  useful  when  occasionally  it  is 
thought  wise  to  institute  a  fast  day,  when  the  only  food  should  consist 
of  apples,  grapes,  pears,  bananas,  or  some  other  variety  of  fruit. 

In  some  sections,  "apple-fasts"  have  been  very  popular  with  many 
persons,  especially  society  matrons  who  have  become  "fair,  fat  and  forty" 
and  are  anxious  to  red\ice  their  weight.  They  are  also  recommended 
in  gouty  diathesis,  chronic  rheumatism  and  chronic  disturbances  of  the 
liver,  Bright's  disease,  and  in  the  condition  of  high  blood  pressure  pre- 
ceding the  development  of  arteriosclerosis,  and  in  intestinal  fermentations 
and  putrefaction,  etc.  "Fasts"  on  apples  alone  do  not -agree  with  all  pa- 
tients, and  there  are  some  individuals  who  believe  they  cannot  abstain 
from  their  ordinary  dietary  for  a  period  of  twenty-four  hours,  even  though 
they  may  consume  large  quantities  of  fruit. 

The  partaking  of  fruit  in  acute  febrile  conditions  is  a  very  ancient 
practice.  Fruits  such  as  grapes,  strawberries,  oranges,  bananas  and  baked 
apples  may  be  taken  with  impunity  in  many  febrile  affections.  Wlien 
studying  the  various  fruits  we  learned  that  the  fruit  juices  are  of  consid- 
erable dietetic  value  in  the  treatment  of  diseases.     The  trophotherapeutic 


546  SPECIAL    DIETS 

action  of  fruit  juices  increases  the  secretion  of  urine  and  its  alkalinity, 
and  stimulates  the  kidneys  ©nd  indirectly  the  skin;  at  the  same  time 
these  juices  act  as  thirst  quenchers.  The  juices  of  grapes,  oranges,  pine- 
apples, currants,  gooseberries,  raspberries  and  strawberries  are  freely 
used  for  this  purpose.  The  juice  of  the  lemon  is  one  of  the  commonest 
articles  in  the  sick  room  in  the  form  6i  lemonade.  The  many  recipes  for 
its  use  in  the  sick  room  will  be  found  elsewhere  in  this  volume.^  The 
juice  of  the  orange  is  also  as  useful  in  illness  as  it  is  palatable  in  health. 
Various  recipes  for  using  orange  juice  will  also  be  found  in  the  reference 
just  cited. 

LEMON  CURE. —  The  "lemon  cure"  is  a  very  ancient  practice  in  the 
treatment  of  obesity  and  the  gouty  diathesis  and  is  highly  recommended 
when  combined  with  thermotherapy.  The  usual  method  is  to  take  the 
expressed  juice  of  three  fresh  lemons  in  sweetened  water  three  times  a 
day  with  the  exclusion  of  milk  and  fatty  foods.  Preserved  lemon  juice 
is  not  as  effective  as  that  of  the  fresh  fruit.  It  is  questionable,  howevei:, 
if  there  is  any  scientific  basis  for  the  consumption  of  lemon  juice  as  an 
anti-fat.  The  manufacturer  of  quack  remedies  for  obesity  uses  a  large 
percentage  of  citric  acid  in  his  remedies  which  are  practically  worthless. 
The  effect  of  lemon  juice  upon  the  food  seems  to  exert  an  inhibitory  power 
over  steapsin  and  amylopsin,  which  retards  the  digestion  of  fat  and  carbo- 
hydrates. 

GRAPE  CURE. — Ampelotherapy,  or  "grape  cure,"  is  probably  the  best 
known  of  the  fruit  cures.  It  is  usually  carried  out  in  southern  Europe 
at  places  like  Meran  and  Montreux,  but  is  available  wherever  grapes  can 
be  obtained.  The  grape  cure  depends  largely  for  its  good  effects  on  change 
of  diet  and  manner  of  life,  the  climate  and  surroundings,  and  the  aperient 
action  of  the  grapes.  When  aided  by  a  simple  supporting  aliment,  it  is 
a  suitable  dietary  for  the  overworked,  the  weak  and  the  convalescent.  It 
is  recommended  in  conjunction  with  the  spare  diet  limited  particularly 
as  to  hydrocarbons  and  carbohydrates,  in  cases  of  abdominal  plethora, 
chronic  bronchitis  and  emphysema,  chronic  constipation,  and  chronic 
gastro-intestinal  catarrh.  Its  use  is  also  valuable  in  the  dietetic  treatment 
of  obesity.  Wlien  the  grape  cure  is  taken  in  Germany,  from  one  to  eight 
pounds  of  grapes  are  eaten  daily  and  little  or  no  other  food  allowed. 
Those  who  take  the  cure  are  expected  to  pick  the  grapes  for  themselves, 
which  insures  exercise  in  the  open  air.  This  method  is  particularly 
adapted  to  the  obese  and  to  those  who  lead  a  sedentary  life.  The  treat- 
ment ordinarily  consists  in  taking  one  pound  or  more  of  grapes  three 


1  Volume  11^  Chapter  XVII,  page  579. 


TUFNELL   AND    BELLINGHAM    DIETS  547 

times  daily  from  half  to  one  hour  before  meals,  the  meals  consisting  of 
light,  easily  digested  foodstuffs,  for  example,  fish,  chicken,  milk  puddings, 
stewed  fruit,  toasts  or  rusks,  and  green  vegetables,  avoiding  all  rich  made 
dishes,  rich  sauces,  pickles,  potatoes,  lentils,  pastry,  cheese  and  sweets. 
The  duration  of  the  course  is  from  four  to  six  weeks.  The  chief  effect 
of  this  alimentation  is  a  laxative  one,  which  renders  it  suitable  in  hepatic 
ailments,  chronic  constipation  and  hemorrhoids.  For  the  analysis  of 
grapes,  see  Volume  I,  Chapter  XIX,  page  752. 

Caultey(14)  recommends  the  following  mode  of  treatment:  "Begin 
with  half  a  pound  of  grapes  when  fasting,  an  hour  or  two  after  a  light 
breakfast,  and  again  at  5  p.m.  In  three  days  give  a  third  half-pound  at 
noon,  or  after  the  midday  meal  if  there  is  dyspepsia.  Gradually  increase 
the  dose  to  one  pound  at  a  time.  The  aperient  effects  are  manifest  in  a 
few  days.  It  is  rarely  advisable  to  give  more  than  two  pounds  in  lung 
cases ;  three  pounds  in  gastric  and  intestinal  catarrh,  the  diet  being  care- 
fully regulated  at  the  same  time ;  and  four  pounds  in  other  conditions ; 
but  the  amount  may  be  increased  to  five  to  six  pounds  for  abdominal 
plethora,  hepatic  constipation  and  chronic  constipation.  Figs  and  prunes 
can  be  added  to  relieve  the  monotony  of  the  diet.  The  course  of  treat- 
ment lasts  for  six  weeks.  Small  quantities  of  white  bread  may  be  eaten 
after  the  grapes  to  remove  acids  from  the  teeth,  and  if  the  gums  become 
irritated,  the  mouth  should  be  rinsed  out  with  bicarbonate  of  soda  solu- 
tion." 

TUFNELL    AND    BELLINGHAM    DIETS 

Tufnell's  diet  for  the  treatment  of  aortic  and  other  aneurisms  is  a 
modification  of  the  methods  formerly  employed  by  Albertini  and  Val- 
salva (19)  in  cases  which  could  not  be  treated  surgically.  The  plan  of 
treatment  was  to  "detain  the  patient  in  bed  for  forty  days,  and  during 
this  period  to  subject  him  to  repeated  bleedings,  while  at  the  same  time 
the  diet  and  drink  were  carefully  ordered,  so  that  the  daily  allowance  ad- 
ministered in  three  or  four  meals  should  never  be  such  as  to  fill  up  the 
blood  vessels.  The  practice  formerly  was  to  diminish  the  quantity  of  meat 
and  drink  gradually  every  day,  until  it  was  cut  down  to  about  half  a 
pound  of  pudding  in  the  morning  and  in  the  evening  half  that  quantity 
and  nothing  else  except  water,  and  this  also  within  a  certain  measure. 
After  having  sufficiently  reduced  the  patient  by  this  method  so  that  by 
reason  of  weakness  he  could  scarcely  raise  his  head  from  the  bed  in  which 
he  lay,  the  quantity  of  aliment  was  increased  again  by  degrees  until  the 
necessary  strength  returned  sufficiently  to  allow  him  to  rise  in  bed." 


548  SPECIAL    DIETS 

Bellingham  in  1852  omitted  the  blood-letting  and  devised  a  method 
which  was  continued  by  Tufnell,  who  in  1875  published  a  monogTaph  on 
the  subject,  the  principal  aim  being  the  reduction  of  the  force  and  fre- 
quency of  the  heart's  action  and  to  favor  the  deposition  of  fibrin  on  the 
wall  of  the  aneurismal  sac.  The  treatment  is  very  debilitating  and  "only 
suitable  for  cases  of  saccular  aneurism  unassociated  with  disease  of  the 
aortic  valve,  and  for  patients  who  are  sufficiently  intelligent  to  understand 
the  importance  of  carrying  it  out  strictly  and  who  have  sufficient  will 
power  to  put  up  with  its  discomforts." 

Bellingham's  dietary  is  very  much  the  same  as  Tufnell's,  both  of 
which  are  given  below.  They  are  modifications  of  the  methods  adopted 
by  Albertini  and  Valsalva,  who  treated  their  patients  by  bloodletting,  rest 
and  modified  diet. 

Bellingham  Tufnell 

Breakfast Milk  or  tea 2  oz.  Milk  or  cocoa 2  oz. 

Bread 2  oz.  Bread  and  butter 2  oz. 

Dinner Liquid 2-4  oz.  Water  or  light  claret 4  oz. 

Bread .1-2  oz.  Bread  or  potato. 3  oz. 

Meat 1-2  oz.  Boiled  or  broiled  meat 3  oz. 

Supper Liquid 2  oz.  Milk  or  tea 2  oz. 

Solid 2  oz.  Bread  and  butter 2  oz. 

Tufnell's  diet  contains  eight  ounces  of  fluid  and  ten  ounces  of  solids. 
It  is  true  that  this  dietary,  or  one  quite  similar,  though  not  so  severe,  has 
often  modified  pain  or  caused  it  to  disappear  entirely,  while  the  aneurism 
has  become  smaller  and  pulsated  less ;  but  many  patients  refer  to  the  cure 
as  worse  than  the  disease.  The  method  of  treatment  as  outlined  by  Caul- 
tey(14)  directs  that  the  "patient  should  rest  on  a  water  bed  and  remain 
absolutely  still,  doing  nothing  whatever  for  himself,  a  restriction  which 
few  people  have  the  strength  of  will  to  adhere  to.  The  mouth  may  be- 
come so  dry  and  parched  that  even  the  limited  amount  of  solids  cannot  be 
taken.  Sucking  a  pebble  or  button  will  relieve  the  thirst  a  little.  An- 
other great  trial  to  the  patient  is  painful  micturition,  because  of  the  ex- 
treme acidity  of  the  urine.  It  can  be  reduced  by  alkalies.  Constipation 
must  be  relieved  by  oil  enemata  if  necessary.  There  is  so  little  waste 
matter  in  the  food  that  an  action  of  the  bowels  once  a  week  is  sufficient. 
The  heart  and  aneurism  must  be  carefully  watched.  If  the  pulse  becomes 
more  and  more  frequent,  the  patient  restless,  and  the  dryness  of  the  mouth 
so  great  that  he  is  unable  to  take  food,  the  treatment  must  be  modified." 

Such  a  restricted  diet  is  no  lono^er  believed  by  able  clinicians  to  be 


WEIR    MITCHELL    DIET  549 

essential  to  good  treatment,  while  an  abstemious,  nutritious  diet  is.  This 
starvation  treatment  is  only  advisable  in  well-nourished  subjects,  espe- 
cially those  with  a  plethoric  temperament.  It  is,  on  the  other  hand,  al- 
together unsuitable  in  weak  or  debilitated  subjects.  In  the  latter  class 
there  is  more  often  than  not  an  enfeebled  digestion  and  it  may  be  advis- 
able in  the  beginning  to  resort  to  a  milk  or  lacto-vegetarian  dietary.  Rest 
in  bed  or  in  mild  cases  gentle  exercise  should  be  insisted  upon.  To-day 
the  iodids  are  almost  universally  relied  upon.  In  recent  years  the  sub- 
cutaneous or  intravenous  injection  of  gelatin  has  been  used  with  some 
success.  Of  course,  the  gelatin  should  be  sterilized  and  the  strictest  care 
taken  to  prevent  sepsis. 

The  important  points  to  keep  in  mind  in  prescribing  a  dietary  in  all 
cases  are,  according  to  Watson (15),  the  following: 

(a)  Restriction  in  the  amount  of  fluids  of  all  kinds.  Not  more  than  from 
20  to  30  ounces  in  the  twenty-four  hours. 

(&)  Meats  and  meat  foods  to  be  given  in  very  sparing  amount,  the  stimulating 
effects  of  these  foods  on  the  circulation  being  prejudicial. 

(c)  A  light,  simple,  nutritious  diet,  given  thrice  daily,  with  no  food  between 
meals.    The  meals  should  be  much  on  the  lines  of  the  diet  laid  down  on  page  548. 

(d)  Alcohol  in  all  its  forms  is  inadvisable,  excepting  in  eases  of  feeble  diges- 
tion, where  its  use  in  small  doses  may  prove  beneficial. 

WEIR    MITCHELL    DIET 

The  Weir  Mitchell  diet(20)  is  recommended  by  the  author  for  the 
dietetic  treatment  of  neurasthenia  and  disorders  of  malnutrition  independ- 
ent of  organic  disease.  The  principal  points  in  carrying  out  this  method 
of  treatment  are  isolation,  massage  and  forced  feeding.  The  isolation 
from  friends,  callers  and  the  family  exerts  a  beneficial  and  moral  effect. 
Massage  and  electricity  aid  in  promoting  digestion  and  the  nutrition  of 
the  muscles.  A  good  nurse  is  essential.  She  must  be  kind,  bright,  sen- 
sible, and  able  to  make  a  favorable  impression  on  the  patient. 

The  patient  should  be  kept  in  bed  for  at  least  six  weeks,  leaving  it  only 
to  go  to  the  toilet.  Mitchell  recommends  that  the  milk  diet  should  be 
instituted  gi'adually,  especially  if  the  patient  has  an  aversion  for  milk. 
It  should  be  given  in  doses  of  one  or  two  ounces  every  two  hours  and 
gradually  increased  until  as  much  as  two  quarts  are  drunk  in  the  twenty- 
four  hours.  In  some  cases  ^Mitchell  recommends  that  the  milk  should  be 
given  even  at  night  as  often  as  every  three  or  four  hours.  At  the  end  of 
the  tenth  day  ap  egg  or  chop  should  be  eaten  at  noon  in  addition  to  the 
usual   allowance  of  milk.     Often  earlier  than  this  Mitchell   prescribes 

135 


550  SPECIAL    DIETS 

meat  juice  once  or  twice  a  day.  A  day  or  two  later  bread  and  butter  are 
given  and  an  egg  or  some  meat  at  breakfast  as  well  as  at  dinner.  By 
degrees  the  patient  is  placed  upon  a  diet  of  three  simple  but  generous 
meals'  daily,  and  in  addition,  three  or  four  pints  of  milk  are  consumed, 
the  latter  being  administered  partly  with  the  meals  and  partly  between 
meals. 

The  following  is  a  synopsis  of  the  management  of  an  individual  case 
of  Weir  Mitchell's  and  is  appended  to  illustrate  the  practical  application 
of  his  rest  cure : 

WETR  MITCHELL'S  DIETARY 

Mrs.  C,  kept  in  bed,  fed  by  an  attendant,  rise  only  to  relieve  bladder  and  rectum. 

First  Day:  One  quart  of  milk  in  divided  doses  every  three  hours. 

Second  Day:  Cup  of  coffee  on  awakening.  Two  quarts  of  milk  in  divided  doses  every 
two  hours.    Aloetic  piU  at  night. 

Third  to  Sixth  Day:  Same  diet. 

Seventh,  Eighth,  and  Ninth  Days:  Same  diet,  with  a  pint  of  raw  soup  in  three  portions. 
This  is  made  by  chopping  up  one  pound  of  raw  beef  and  placing  it  in  a  bottle  with 
a  pint  of  water  and  five  drops  of  strong  hydrochloric  acid.  The  mixture  stands 
in  ice  all  night;  in  the  morning  the  bottle  is  put  into  a  pan  of  water  at  IIC^  F., 
and  kept  two  hours  at  about  that  temperature.  This  mixture  is  then  thrown  into 
a  stout  cloth  and  strained  until  the  mass  that  remains  is  nearly  dry.  If  the  raw 
taste  proves  very  objectionable,  the  beef  to  be  used  is  first  quickly  broiled  on 
one  side  and  then  the  process  is  completed  in  the  manner  previously  described. 

Tenth  Day:  7  a.m.,  Coffee;  7.-30  a.m.,  10  a.m.,  12  m.,  2,  4,  6,  8,  10  p.m.,  Half  a  pint  of 
milk;   11  a.m.,  5  and  9  p.m..  Soup. 

Fourteenth  Day:  Eggs,  and  bread  and  butter  added. 

Sixteenth  Day:  Dinner  added  and  iron. 

Nineteenth  Day:  The  entire  diet  was  as  follows :  7  a.m.,  Coffee;  Breakfast,  8  a.m..  Iron 
and  malt  extract,  chop,  bread  and  butter,  a  tumbler  and  a  half  of  milk ;  Lunch, 
11  A.M.,  Soup;  Dinner,  2  p.m.,  Anything  liked,  with  six  ounces  of  Burgundy  or 
dry  champagne,  and  at  the  end  one  or  two  tumblers  of  milk.  Iron  and  malt; 
Tea,  4  p.m..  Soup;  Supper,  7  p.m..  Malt,  iron,  bread  and  butter,  usually  some 
fruit,  and  two  glasses  of  milk;  Late  Supper,  9  p.m.,  Soup;  10  p.m.,  Aloetic  pill. 
At  12  noon,  massage  for  an  hour.     At  4.30  p.m.,  electricity  applied  for  an  hour. 

Sixth  Week:  Soup  and  wine  were  dropped,  iron  lessened  one-half;  massage  and  elec- 
tricity only  on  alternate  days;  1/30  of  a  grain  of  strychnin  sulphate  thrice  a 
day  at  meals  given  (continued  for  several  months). 

Ninth  Week:  Milk  reduced  to  a  quart.    All  mechanical  treatment  ceased. 

Result:  Gain  in  flesh  about  face  in  second  week.  Weight  rose  in  two  months  from 
96  to  136  pounds;  gain  in  color  equally  marked.  On  thirtieth  day  patient  had 
normal  catamenial  flow  after  five  years  of  failure  to  menstrjiate.  Ninth  week, 
drove  out.    Cure  complete  and  permanent. 


WEIR    MITCHELL    DIET  551 

By  the  end  of  the  sixth  week  of  this  treatment,  the  patient  niav  be 
returned  to  a  full  diet  and  in  addition  take  at  least  from  GO  to  80  ounces 
of  milk  per  day. 

FULL    NEURASTHENIA    DIETARY    (Weir    Mitchell) 

Early  Breakfast,  7  a.m.  : 
10  ounces  of  milk. 
Breakfast,  8.30  a.m.: 

Plate  of  porridge  or  gruel,  or  hominy;  or  bowl  of  bread  and  milk  with  a  gill  of 
cream;   fish,  bacon,  eggs,  or  kidney ;   cocoa  or  coffee;   bread  or  rolls;   butter  or 
marmalade. 
Lunch,  9  A.M.: 

10  ounces  of  milk. 
Second  Lunch,  \\  KM.: 

Cup  of  beef  tea  with  2  teaspoonfuls  of  beef  peptonoids. 
Dinner,  1 .30  p.m.  : 

Fish,  tripe,  sweetbread,  cutlets,  game  or  poultry,  served  with  one  .vegetable,  with 
a  sweet  such  as  stewed  fruit;   10  ounces  of  milk  to  be  sipped  slowly  during  this 
meal. 
Afternoon  Lunch,  4  p.m.  : 

10  ounces  of  milk  with  sponge  cake;  bread  and  butter,  or  rusk. 
Supper,  6.30  p.m.  : 

A  three-course  meal.    Soup  or  fish;  joint  or  poultry;  sweet  or  savory,  or  dessert; 
taking  with  meal  10  ounces  of  milk. 
Late  Supper,  8.30  p.m.  : 

Beef  tea  and  2  teaspoonfuls  of  peptonoids. 
10  P.M.: 

10  ounces  of  milk. 

Occasionally  a  physician  is  called  upon  to  attend  a  stout  patient  with 
flabby  nm.sclcs  presenting  the  usual  symptoms  of  neurasthenia.  In  the 
successful  handlini>'  of  this  type  of  patients,  a  mild  starvation  is  a  ne<*es- 
sary  prelimin.ary  for  a  few  days  prior  to  beginning  the  Weir  Mitchell 
treatment.  This  method  of  treatment  is  recommended  by  Pla^'fair  as  fol- 
lows : 

Confine  patient  strictly  to  bed;  diet  with  skimmed  milk,  at  first  two  quarts 
per  diem,  given  in  small  quantities  every  two  hours;  after  a  day  or  two  lessen 
this  gradually  till  not  more  than  a  pint  per  diem  is  taken.  If  the  patient's  strength 
fail  unduly  under  this,  some  beef  tea  or  soup  may  l)e  temporarily  substituted  for 
the  milk.  lender  the  minimum  diet  the  weight  gradually  loses  about  ^/^  pound 
per  diem  (the  patient  should  be  weighed  every  second  d.iy),  and  when  some  14 
to  20  pounds  have,  been  taken  off,  pure  milk  may  be  substituted  for  skinuucd, 
and  the  treatment  as  detailed  above  pursued. 


552  SPECIAL    DIETS 

TRAINING    DIET 

The  training  diet  is  a  question  which  has  been  agitated  during  recent 
years  by  the  leaders  in  held  athletics  at  the  greater  schools  and  universities 
both  of  this  country  and  Europe (21).  Of  late,  a  great  deal  has  been 
written  pertaining  to  the  diet  best  adapted  for  athletes,  both  amateur  and 
professional,  when  training  for  a  contest,  in  order  to  have  them  physically 
lit  for  feats  of  ^endurance.  The  necessity  of  this  training  is  fully  recog- 
nized by  all  athletes,  and  while  opinions  may  differ  as  to  the  methods, 
there  is  more  or  less  accord  in  the  ideal  that  is  sought.  The  object  of 
training  is  to  put  a  man  in  condition  to  execute  a  large  amount  of  work, 
and  sometimes  skilled  work,  in  a  very  short  period  of  time,  which  is  quite 
a  different  problem  from  feeding  a  laborer  or  artisan.  The  latter  re- 
quires an  alimentation  which  will  enable  him  to  do  a  large  amount  of 
work  daily,  continuing  over  a  long  period  of  time. 

The  usual  training  diet  has  been  based  on  a  liberal  allowance  of  meat, 
on  the  assumption  that  the  wear  and  tear  of  muscular  tissue  is  gi*eat  and 
that  meat  is  the  greatest  source  of  strength  and  less  fattening  than  other 
foods.  The  great  nervous  and  muscular  energy  of  carnivorous  animals 
is  often  quoted  to  substantiate  this  assumption.  We  know  that  the  race 
horse  is  the  fastest  animal  for  a  reasonable  distance,  but  certain  species  of 
the  carnivora  can  maintain  a  short  burst  of  speed  which  will  exceed  that 
of  the  race  horse.  It  is  not  questioned  that  a  liberal  supply  of  animal 
food  is  suitable  for  a  short  distance  runner,  but  it  certainly  is  not  a  suit- 
able diet  for  prolonged  exertion,  as  may  be  seen  in  the  case  of  the  Japan- 
ese, who  on  a  vegetable  diet  are  able  to  run  continuously  for  hours  at  a 
time  and  drag  a  jinrikisha  occupied  by  a  passenger. 

The  general  principles  of  training  are:  (a)  the  reduction  of  weight 
by  the  removal  of  superfluous  fat;  (b)  the  improvement  of  the  tone  of  the 
muscles  and  heart,  inducing  long  "wind"  and  endurance.  During  the 
period  of  preparation  for  an  athletic  test,  muscles  must  be  made  to  grow 
and  the  waste  caused  by  trial  tests  of  strength  be  repaired.  Proteins  are 
necessary  for  cell  growth  and  repair,  as  well  as  to  furnish  nervous  energy. 

Although  carbohydrates  are  an  economical  source  of  a  large  number 
of  calories  or  units  of  energy,  so  that  muscular  work  can  be  performed 
on  such  a  diet,  nevertheless  rapid  and  accurate  muscular  work,  that 
entailing  correct  correlation  of  movements,  demands  much  nervous  energy, 
and  for  this  type  of  Avork  proteins  are  necessary.  Under  conflitions  re- 
quiring the  ingestion  of  large  quantities  of  food,  a  generous  proportion  of 
proteins  should  be  furnished  on  account  of  their  ease  of  digestion.     The 


TRAINING   DIET  553 

carbohydrate  intake  should  be  carefully  chosen  and  skillfully  prepared, 
so  that  this  part  of  the  diet  may  also  be  easily  digested.  Professional 
athletes  recognize  the  importance  of  keeping  "fit"  and  being  in  perfect 
trim  in  order  to  perform  feats  of  strength  and  endurance.  In  a  well- 
trained  athlete  the  muscles  are  hard  and  lirm..  the  fat  is  reduced  to  a 
minimum,  the  skin  is  clear,  the  eyes  bright,  the  expression  indicative  of 
perfect  health,  the  body  is  active  and  the  ''wind"  good. 

The  length  of  time  necessary  to  train  varies  with  the  previous  habits 
and  mode  of  life  of  the  individual.  Ordinarily,  the  average  college  youth 
of  the  athletic  type  can  be  put  in  fit  condition  in  six  weeks,  and  it  must 
be  borne  in  mind  that  the  transition  from  ordinary  habits  to  those  of  train- 
ing should  be  gradual  both  as  to  the  regulation  of  the  alimentation  and 
of  exercise. 

Practice  and  experience  have  emphasized  the  advisability  of  a  gener- 
ous mixed,  liberal,  full  diet  as  the  one  calculated  to  put  an  athlete  in  the 
best  trim.  At  the  training  tables  of  the  Harvard  and  Yale  crews  such 
food  as  the  following  is  eaten :  Good  lean  beef  or  mutton,  best  given  under- 
done, toast  made  from  stale  bread,  and  potatoes  and  green  vegetables  of 
all  kinds.  Fruits,  beef,  lamb,  mutton,  chicken,  fish,  bacon  and  eggs,  and 
simple  puddings  are  allowed,  but  no  highly  seasoned  food  is  permit- 
ted (22).  The  following  articles  are  prohibited:  entrees,  rich  puddings, 
pastries,  sauces,  pickles,  spices,  appetizers,  and  all  fanet  and  complex 
dishes.  Made  dishes  or  dishes  made  from  twice-cooked  meats,  all  spirits 
and  strong  alcoholic  drinks,  as  well  as  tea,  cofFee  and  nerve  stimulants  are 
prohibited.  Tobacco,  in  all  forms,  is  strictly  forbidden.  Water  is  allowed 
in  liberal  quantities,  but  if  there  is  a  tendency  to  obesity,  the  amount  is 
somewhat  limited,  the  quantity  being  gradually  reduced  and  only  suffi- 
cient quantity  allowed  to  allay  thirst.  We  have  already  referred  to  carbo- 
hydrates as  producers  of  strength.  In  this  connection  it  is  interesting  to 
note  the  experiences  of  the  Holland  oarsmen,  who,  according  to 
Davis(28),  "while  in  training  began  to  show  signs  of  overwork,  loss  of 
flesh,  a  lack  of  ambition  and  energy,  and  a  disinclination  for  study  and 
work.  By  eating  sugar  as  freely  as  they  wished,  sometimes  as  much  as 
one-third  of  a  pound  a  day,  they  were  refreshed  and  able  to  win  the  race 
against  the  antagonists  who  did  not  believe  in  its  use."  Sugar,  a  crystal- 
lized carbohydrate,  is  permitted  as  an  adjunct  to  the  dietary  of  the  athlete 
in  training,  but  pies,  cakes  and  other  sweets  and  more  or  less  indigestible 
dishes,  as  already  pointed  out,  should  be  forl)idden(24). 

Atwater  and  Bryant(25)  conducted  experiments  on  this  particular 
question,  from  which  we  cite  the  following : 


554  SPECIAL    DIETS 

Two  young  men,  with  only  two  hours  a  day  for  practice,  at  the  end  of  two 
months  entered  for  the  race.  No  change  had  been  made  from  their  usual  diet, 
except  that  they  ate  as  much  sugar  as  they  wished,  sometimes  as  much  as  a  third 
of  a  pound  at  the  time  of  their  daily  exercise.  One  of  them,  however,  did  not 
make  this  addition  to  his  diet  until  the  third  week,  when  he  began  to  show  all  the 
signs  of  overtraining — loss  of  weight  and  a  heavy,  dull  feeling,  with  no  desire 
for  study.  On  the  third  day  after  beginning  the  use  of  sugar  these  symptoms 
disappeared.  At  the  time  of  the  race  both  youths  were  victorious  over  their 
antagonists,  who  did  not. believe  in  the  use  of  sugar.    No  bad  effects  were  observed. 

An  athlete  in  training  must  ingest  more  food  and  in  larger  amounts 
than  a  person  of  the  same  physique  following  an  ordinary  vocation, 
but  care  must  be  taken  not  to  overeat  and  thereby  derange  digestion;  nor 
must  the  meals  be  eaten  at  too  long  intervals. 

The  following  report  of  the  Yale  crew,  on  the  authority  of  Dr.  Hart- 
well,  formerly  a  captain  of  the  University  crew  and  of  the  University 
football  team,  is  quoted  from  Thompson  (26)  : 

The  training  covered  a  period  of  ten  and  one-half  weeks. 

DIETARY,  YALE  TRAINING  CREW 
Breakfast,  7.30  a.m.  : 

Fruits  (oranges,  tamarinds,  figs,  and  grapes);  cereals  with  rich  milk  and  sugar, 
etc.;  beefsteak,  usualh'  rare;  chops,  stews,  hash,  with  once  or  twice  a  week 
some  salt  meat,  as  bacon  or  ham,  usually  accompanied  by  liver;  stewed, 
browned,  or  baked  potatoes;  eggs  served  in  different  ways;  oatmeal- water  and 
milk  as  beverage,  with  tea  on  special  occasions  for  some  particular  individual. 
Dinner,  1  p.m.: 

Soups,  meats,  fish,  vegetables,  with  a  simple  dessert,  such  as  rice,  bread,  or  tapioca 
pudding,  some  fruit,  and  the  same  beverages  as  at  breakfast  were  also  used. 
The  meats  included  roast  beef,  mutton,  or  chicken,  two  kinds  being  always 
served.  But  little  gravy  was  used.  Fish  was  served  twice  a  week.  The  vege- 
tables included  potatoes,  mashed  or  boiled;  tomatoes,  peas,  beans,  and  com. 
Two  vegetables  besides  potatoes  were  usually  served. 
Supper,  8  to  8.15  p.m.:' 

Cereals,  as  at  breakfast;   chops,  stews,  or  cold  meat  from  dinner;   rarely  beef- 
steak; potatoes,  stewed  or  baked;  and  eggs  about  three  times  a  week,  usually 
not  on  the  same  days  that  they  were  served  for  breakfast.    Sometimes  ale  was 
permitted  to  some  individual. 
After  the  crews  were  in  final  preparation  for  the  race  at  New  London  the  diet 
varied  somewhat :  Breakfast  and  dinner  remained  about  the  same,  but  a  light  luncheon 
of  cold  meat,  stewed  or  baked  potatoes,  milk  and  toast  was  served  at  4.30  in  the  after- 
noon.   After  this  the  evening  exercise  was  engaged  in  for  about  two  hours.     Forty- 
five  minutes  after  this  was  completed  cold  oatmeal  or  other  cereal  with  milk  and  toast 
was  served.    A  light  supper  was  served  at  9.30,  just  before  the  men  retired.    This 
diet  was  much  more  liberal  than  that  served  ten  years  before.    The  men  were  allowed 
as  much  food  as  they  desired. 


TKAINING    DIET 


555 


The  table  of  dietary  studies  incorporated  lierewith  is  taken  from  the 
extensive  studies  of  Atwater  and  Bryant,  giving  the  suinniary  of  results 
of  dietary  studies  of  university  boat  crews,  football  teams,  and  of  pro- 
fessional athletes,  and  compares  them  with  the  standard  dietaries  of  men 
engaged  in  various  occu])ations. 

DIETARY  STUDIES  OF  UNIVERSITY  BOAT  CREWS 
Nutrients  Actually  Eaten  per  Man  per  Day 


Crews 

Protein, 
grams 

Fat, 
grams 

Carbo- 
hydrates 
grams 

Calories 

Harvard  University  Crew 

162 
153 
145 
160 
135 
171 
155 

175 
223 
170 
170 
152 
171 
181 

449 

468 
375 

448 
416 
434 

487 

4,130 

Harvard  Freshman  Crew 

4,620 

Yale  University  Crew 

Harvard  University  Crew  (Gales  Ferry) .  . 
Harvard  Freshman  Crew  (Gales  Ferry)..  . 

Yale  University  Crew  (Gales  Ferry) 

Captain  Harvard  Freshman  Crew   

3,705 
4,075 
3,675 
4,070 
4,315 

Average 

155 

177 

440 

4,085 

It  is  interesting  to  note  that  these  dietaries  for  the  university  crews 
are  very  similar  to  that  advised  for  Americans  during  a  period  of  hard 
work.  They  are  a  little  fuller  than  the  English  and  German  standards. 
Football  teams  lead  in  the  quantity  of  food  ingested.  Relative  to  the 
other  carbonaceous  foods,  the  proportion  of  protein  is  markedly  increased. 
Comparing  the  dietary  of  college  students  in  training  with  that  of  an 
ordinary  college  club,  the  excess  of  proteins  in  the  former  is  very  notice- 
able. The  average  diet  of  a  training  crew  contains  155  grams  of  protein 
and  yields  4,085  calories,  making  a  difference  in  fuel  energy  between  the 
two  of  al)out  400  calories.  The  diet  furnished  the  oarsmen  at  Gales  Ferry 
yielded  the  oarsmen  one-ninth  more  energy  than  that  of  the  men  not  en- 
gaged in  athletic  work.  In  other  terms  the  difference  amounted  to  48 
grams  or  an  increase  of  nearly  one-half  of  protein. 

Atwater  and  Bryant(27)  outlined  the  following  account  of  the  dietary 
of  the  Harvard  boat  crew  at  Cambridge: 

The  diet  was  simple,  and  consisted  of  roast  and  broiled  beef  and  lamb, 
fricasseed  chicken,  roast  turkey  and  broiled  fish.  Eggs,  raw,  poached  or  boiled 
in  the  shell,  were  used  plentifully.  Large  amounts  of  milk  and  cream  were  also 
consumed.  Oatmeal,  hominy  and  shredded  wheat  were  eaten  extensively,  and 
com  cakes  were  served  occasionally.  Bread  was  almost  always  taken  in  the  form 
of  dry  toast.  Potatoes  were  served  twice  a  day,  either  baked  or  boiled  and 
maslied,  with  the  addition  of  a  little  milk  and  butter;  occasionally  they  were 
creamed.     Boiled  rice,  prepared  with  a  little  cream  and  sugar,  was  served  instead 


556 


SPECIAL   DIETS 


of  potatoes  at  some  meals.  Beets,  parsnips,  green  peas  and  tomatoes  were  used 
to  furnish  a  variety  of  vegetables.  Macaroni  was  occasionally  served.  For  des- 
sert, apple,  tapioca,  custard,  or  other  pudding  containing  a  large  proportion  of 
milk  and  eggs,  was  served.  The  members  of  the  crew  were  allowed  beer  once  a 
day.  Milk  was  obtained  from  one  of  the  large  creameries  supplying  that  vicinity, 
and  was  of  unusually  good  quality,  containing  5.8  per  cent  of  butter  fat.  A  very 
thick,  heavy  cream  was  also  used,  diluted  about  one-half  with  milk.  This  mixture, 
or  thin  cream,  contained  about  16  per  cent  of  butter  fat. 

The  animal  food  consumed  during  this  study  was  entirely  from  the  loin  of 
the  beef.  Occasionally  the  roasts  were  from  the  fillet,  and  at  other  times  the 
ordinary  loin  roast  with  the  bone  was  used.  The  meat  was  sliced  in  liberal  por- 
tions, being  previously  practically  freed  from  all  the  clear  fat  and  tissue,  and 
sent  to  the  table  on  a  large  platter  from  which  the  men  were  served  individually. 
The  beef  was  cooked  underdone  and  served  rare.  When  the  beefsteak  was  served, 
it  was  freed  from  the  bone,  nearly  all  of  the  visible  fat  being  removed.  Lamb- 
chops  were  served  with  the  bone.  Lamb  and  mutton  roasts  were  all  taken  from 
the  leg,  and  were  also  clear  meat,  trimmed  free  from  visible  fat.  The  turkey 
used  was  shipped  from  a  distance  and  had  been  in  cold  storage.  It  was  baked 
with  stuffing  and  dressing,  although  very  little  of  the  latter  was  served  to  the 
crew.  Chicken  was  always  prepared  fricasseed  and  served  free  from  bone,  except 
the  leg  and  wing.  Fish  was  usually  served  for  breakfast,  bluefish  and  Spanish 
mackerel,  broiled.  Eggs,  either  raw  or  poached,  were  also  allowed.  No  pastry 
was  permitted,  and  puddings,  as  previously  stated,  were  composed  largely  of  eggs 
and  milk-.  No  fresh  fruit  except  oranges  for  breakfast  was  permitted.  Stewed 
prunes,  rhubarb,  or  apples  were  eaten  most  abundantly.  No  beverages  other 
than  water  or  beer  were  allowed. 

Yeo(28)  gives  the  dietary  of  tlie  English  boat  crews  at  Oxford  and 
Cambridge.     It  may  be  interesting  in  this  connection  to  compare  the 

A  DAY'S  TRAINING  FOR  THE  SUMMER  RACES 


Oxford 
7  A.M. : 

Rice;   a  short  walk  or  run. 
Breakfast,  8.30  a.m.: 

Underdone  meat;    crust  of  bread  or 
dry  toast;   tea  (as  little  as  possi- 
ble). 
Dinner,  2  p.m.  : 

Meat  (as  at  breakfast);  bread;  no* 
vegetables  (not  strictly  adhered 
to) ;   1  pint  of  beer. 

5  or  5.30  P.M. 

Rowing  exercise. 
Supper,  8.30  or  9  p.m. 

Cold  meat  or  bread;  sometimes  jelly 
or  water-cress;   1  pint  of  beer. 
10  p.m.: 

Retire  to  bed. 


Cambridge 
A  run  of  200  yards  as  fast  as  possible. 

Underdone  meat;  dry  toast;  tea,  2 
cups  (later  only  1>^);  water-cress 
(occasionally). 

Meat  (as  at  breakfast);  bread,  pota- 
toes, and  greens;  1  pint  of  beer. 
Dessert:  oranges,  biscuit,  or  figs;  2 
glasses  of  wine. 

Rowing  exercise. 

Cold  meat;  bread;  lettuce  or  water- 
cress;  1  pint  of  beer. 


TIlAINi:^^G   DIET  557 

A  DAY'S  TRAINING  FOR  THE  WINTER  RACES 

Oxford  Cambridge 

7.30  a.m.:  7  a.m.: 

Rice.    A  short  walk  or  run.  Exercise  as  for  summer  races. 

Break-fast,  9  a.m.  :  Breakfast,  8.30  a.m.  : 

As  in  summer.  As  in  suoimer. 

Luncheon,  1  p.m.: 

Bread  or  a  sandwich  and  ]/2  pint  of  A  Uttle  cold  meat;  bread  and  ]/2  pii^t 

beer.  of  beer,  or  biscuit  and  glass  of  sherry 

(sometimes  yolk  of  egg  in  the  sherry) . 
2  P.M. : 

Rowing  exercise.  Rowing  exercise. 

Dinner,  5  p.m.  :  Dinner,  5  to  6  p.m.  : 

Meat  as  in  summer;    bread;    same  As  in  summer, 

rule  as  in  summer  as  to  vegeta- 
bles; rice  pudding  or  jelly;  3^  pint 
of  beer. 
10  p.m.: 

Retire  to  bed. 

Water  strictly  forbidden.     As  little 
liquid  to  be  drunk  as  possible. 

English  dietaries  with  the  dietaries  at  Yale  and  Harvard.  Maclareu  gives 
the  following  schemes  of  training  as  carried  out  at  Oxford  and  Cam- 
bridge : 

In  making  a  resume  of  the  results  of  their  observations,  Atwater  and 
Bryant  state  that,  in  a  "general  way,  the  difference  between  the  food  of 
the  athletes  and  that  of  other  people  represents  a  difference  in  actual  phys- 
ical need  even  if  neither  is  an  accurate  measure  of  that  need."  The  prin- 
cipal difference  in  the  food  of  athletes  as  compared  with  that  consumed 
by  ordinary  working  people  or  college  men  is  that  the  dietary  of  the 
former,  owing  to  the  large  percentage  of  protein,  is  productive  of  a  larger 
amount  of  energy.  An  increase  of  protein  is  necessary,  not  so  much  to 
provide  additional  energy  as  to  make  good  the  wear  and  tear  of  the  strain, 
on  muscular  tissue  expended  in  the  performance  of  strenuous  exercise  or 
laborious  work,  as  well  as  in  certain  cases  to  enable  the  muscle  to  add  sub- 
stance to  its  bulk.  The  daily  excess  of  the  athletic  diet  over  ordinary  diet 
is  about  400  calories  or  10  per  cent.  The  amount  of  protein  consumed  in 
the  Atwater  experiments  was  about  45  per  cent  above  standard  dietaries. 
"In  other  words,  the  difference  in  protein  was  four  and  one-half  times  as 
great  as  the  difference  in  fuel  value,  and  the  excess  in  protein  would  ac- 
count for  a  considerable  part  of  the  excess  of  energy  of  the  diet  of  the 
athletes  as  compared  with  men  in  ordinary  occupation." 

In  the  final  summing  up  of  their  research  and  experiments,  Atwater 
and  Bryant  record  the  following  interesting  observations: 


558  .      SPECIAL    DIETS 

In  this  connection  it  is  interesting  to  observe  that  many  physiologists  are 
coming  to  entertain  the  view  that  the  amount  of  metabolism  in  the  body  is  regu- 
lated not  simply  by  the  muscular  work,  but  also  by  the  nervous  effort  required  in 
the  performance  of  this  work.  The  especially  large  proportion  of  protein  ob- 
served in  the  dietary  studies  of  the  university  boat  crews,  of  football  teams,  of  the 
professional  athlete  and  of  the  pugilist,  as  compared  with  the  dietary  studies  of 
college  men  with  ordinary  exercise,  and  with  ordinary  families  of  workingmen  and 
professional  men,  accords  well  with  a  view  not  uncommon  of  late  among  physi- 
ologists. According  to  this  view,  men  who  perform  continued '  muscular  labor, 
even  if  it  is  active  enough  to  make  the  total  amount  large,  do  not  require  espe- 
cially large  amounts  of  protein  in  their  food  so  long  as  they  undergo  no  especial 
mental  strain  or  muscular  fatigue,  the  principal  requirements  being  an  abundant 
supply  of  easily  digested  food  material.  On  the  contrary,  when  a  man  or  animal 
must  perform  intense  muscular  work  for  a  short  period  of  time,  and  is,  there- 
fore, under  more  or  less  nervous  as  well  as  muscular  strain,  a  considerably  larger 
supply  of  protein  seems  to  be  required  than  under  normal  conditions  of  slow, 
long-continued  work.  In  other  words,  if  a  large  amount  of  work  must  be  done 
in  a  short  time,  a  considerable  excess  of  protein  is  required  in  the  food.  This 
view,  which  has  been  especially  advocated  by  Zuntz(29),  seems  to  be  favored  by 
the  results  of  dietary  studies  above  discussed. 

Recent  experiments  made  by  Dunlop,  Paton,  Stockman  and  Mac- 
adam (30)  have  to  do  with  the  amount  of  protein  required  when  severe 
muscular  work  is  performed.  The  results  are  discussed  with  especial  ref- 
erence to  training,  and  are  believed  to  "show  the  importance  of  two  points 
long  known  to  athletes  and  others  doing  excessive  muscular  work." 

The  one  is  the  importance  of  proper  training,  for  by  it  an  abstraction  of 
protein  matter  from  tissues  other  than  muscle  can  be  avoided;  the  other  is  the 
importance  of  there  being  a  sufficiency  of  protein  in  the  diet  to  compensate  for 
the  loss  which  occurs.  An  abundance  of  protein  in  the  diet  of  an  athlete  has 
other  functions  to  fulfill  besides  this.  It  is  required  during  training  for  building 
up  the  energy-liberating  mechanism — the  protoplasm  of  muscle;  and  it  is  also 
required  after  work  to  repair  that  mechanism.  The  benefits  of  training  are  well 
known  in  other  ways,  such  as  preparing  the  heart  for  suddenly  increased  duty 
and  limiting  the  after  fatigue  effects. 

The  power  of  the  body  to  perform  the  maximum  of  muscular  work  within  a 
comparatively  short  time  and  with  a  minimum  amount  of  fatigue  is  secured  by 
means  of  training.  Of  course,  skill  in  application  of  muscular  strength  is  as 
essential  as  is  the  amount  of  power  exerted.  The  skill  is  sought  by  exercise  and 
practice.  The  object  of  regulating  the  diet  in  training  is  not  only  to  furnish  the 
material  to  supply  the  power,  but  also  to  put  the  machine  in  the  best  condition 
for  developing  as  well  as  applying  the  power.  In  other  words,  the  man  is  to  be 
subjected  for  a  short  time  to  intense  muscular  strain  and  considerable  nervous 
effort.  This  he  is  to  bear  with  a  maximum  of  result  and  the  minimum  of  fatigue. 
For  this  he  needs  practical  training,  on  the  one  hand,  and  proper  diet,  on  the 
other.     If  the  views  above  presented  are  correct,  the  diet  for  men  from  whom 


KEDUCING   DIETARY  551) 

intense  muscular  effort  is  required  for  short  periods  should  supply  liberal  amounts 
of  energy  and  especially  large  amounts  of  protein. 

REDUCING    DIETARY 

A  reducing  dietary  may  be  so  planned  that  one  may  dine  both  well 
and  wisely,  ojnitting  the  fat-forming  foods.  Of  late,  the  slim,  sylph-like 
iigiire  has  become  fashionable,  and  the  physician  is  daily  importuned 
with:  "Doctor,  what  shall  I  do  to  reduce?"  When  a  society  matron  be- 
comes "fair,  fat  and  forty,"  she  is  desperate  to  reduce  and  will  rigidly 
adhere  to  any  dietary  her  physician  will  outline.  Lately  both  men  and 
women  of  the  first  "four  hundred"  have  fasted  and  fumed,  boiled  in 
Turkisli  baths,  and  rolled  the  floor  in  various  gyratory  calisthenic  con- 
tortions, strenuously  fighting  the  tragedy  of  fat. 

We  have  previously  pointed  out  that  everyone,  as  a  rule,  and  more 
especially  the  corpulent  individual,  eats  too  much  and  sleeps  too  much. 
In  the  majority  of  instances,  corpulency  is  due  directly  to  overeating,  and 
the  average  dietary  consists  largely  of  fat-making  foods,  from  soups  to 
nuts.  It  follows  then  that  the  natural  cure  for  corpulency  is  to  restrict 
the  ingestion  of  fat-producing  foods — carbohydrates  and  hydrocarbons. 
Of  the  former,  Mahdah  advises  the  elimination  from,  the  dietary  of  the 
following :  bread,  biscuits,  crackers,  and  anything  made  from  wheat,  corn, 
rye,  barley,  oats,  cereals  and  breakfast  foods;  rice,  macaroni,  potatoes 
and  dried  legumes;  pies,  cakes,  puddings,  pastries  and  custards;  candies, 
bonbons  and  all  sweets,  including  ice  cream  and  sirup-sweetened  soft 
drinks.  Of  the  latter  class,  we  would  advise  the  total  abstinence  from 
pork,  ham,  bacon  and  the  fat  of  any  meat;  milk,  cream,  cheese,  butter, 
olive  oils  and  any  foods  seasoned  with  grease  (Mahdah  menus). 

At  first  glance,  it  would  seem  that  there  is  little  left  to  eat,  but  one 
may  dine  Avell  and  wisely  from  a  menu  made  up  of  the  following:  All 
kinds  of  meat  except  swine  flesh ;  all  kinds  of  game,  including  fowls ;  all 
kinds  of  sea  food,  fish,  lobsters,  clams  and  oysters;  all  fresh  and  dried 
fruit  with  the  exception  of  grapes  and  bananas;  all  varieties  of  salad  made 
from  h'o-i\\  vegetables  and  served  with  dressings  free  from  olive  oil :  all 
types  of  meat  jellies;  cucumbers,  celery,  mushrooms,  tomatoes,  olives, 
pickles  and  chili  and  Worcestershire  sauce.  Of  green  vegetables,  any  of 
the  following  are  permissible:  Brussels  sprouts,  string  beans,  cauliflower, 
beets,  spinach,  lettuce,  beet-tops  and  turnip-tops  cooked  as  purees,  carrots, 
squash,  celery  root,  salsify,  cabbage,  endives,  artichokes,  radishes,  par- 
snips, eggplant,  onions,  asparagus  (Vance  Thompson,  Mahdah V 

From  the  foregoing,  a  menu  can  be  made  up  that  will  be  satisfying 


560  SPECIAL   DIETS 

and  contain  sufficient  food  value  for  healthful  maintenance.  In  Mahdah's 
"Eat  and  Grow  Thin"  ^  will  be  found  menus  especially  calculated  to  get 
rid  of  excess  fat.  By  following  these  menus  religiously,  it  is  believed 
that  corpulent  individuals,  without  question,  lose  from  fifteen  to  thirty 
pounds  within  a  period  of  three  months.  It  will  be  noted  that  these  menus 
do  not  provide  for  breakfast.  This  meal  consists  largely  of  fresh  or 
stewed  fruit  and  twice  a  week  boiled  or  poached  eggs  may  be  served ;  tea 
or  coffee  is  allowed  without  cream  or  milk;  other  than  this,  no  fluids  are 
to  be  taken  with  the  meals.  Of  course,  between  meals  sufficient  water  to 
quench  thirst  may  be  taken  with  impunity. 

DIET  FOR  PROFESSIONAL  SINGERS  AND  LECTURERS 

Beyond  qi:estion  diet  exerts  more  or  less  influence  on  the  fullness  and 
richness  of  the  voice.  A  hearty  meal  interferes  with  full,  free  respiration 
to  the  extent  that  singing  is  practically  or  even  entirely  impossible.  The 
vocal  cords  may  become  congested  following  the  ingestion  of  food  or  drink, 
and  smoking  often  exerts  an  injurious  effect  upon  the  voice.  Alcoholic 
drinks  imbibed  to  excess,  as  well  as  irritating  articles  of  food,  may,  and 
often  do,  impair  the  tone  of  the  voice  and  should  be  omitted. 

Opera  singers  possess  peculiar  and  curious  idiosyncrasies.  Certain 
articles  of  alimentation  exert  a  deleterious  effect  upon  the  voice  of  some, 
while  the  same  food  will  have  just  the  opposite  effect  on  others.  Ruh- 
rah(31),  quoting  Russell  in  "Representative  Actors,"  delineates  an  inter- 
esting list  of  foods  and  beverages  partaken  of  by  prominent  stage  folk 
prior  to  appearing  before  the  footlights.  He  states  that  "Edmund  Kean, 
Emery  and  Reeve  drank  cold  water  and  brandy;  John  Kemble  took 
opium ;  Lewis,  mulled  wine  and  oysters ;  Maeready  was  at  one  time  accus- 
tomed to  eat  the  lean  of  a  mutton  chop  previous  to  going  on  the  stage,  but 
subsequently  lived  almost  exclusively  on  a  vegetarian  diet ;  Oxbury  drank 
tea ;  Henry  Russell  ate  a  boiled  egg ;  W.  Smith  drank  coffee ;  Braham 
drank  bottled  porter ;  Miss  Catley  took  linseed  tea  and  ^Madeira ;  G.  F. 
Cook  would  drink  anything;  Henderson  used  gum  arable  and  sherry; 
Incledon  drank  Madeira ;  Mrs.  Jordan  ate  calves'-foot  jelly  and  sherry ; 
C.  Kean  took  beef  tea :  Mrs.  Wood  sang  on  draught  porter ;  Harley  took 
nothing  during  a  performance.  Malibran,  it  is  said,  ate  a  lunch  in  his 
dressing-room  half  an  hour  before  singing.  This  consisted  of  a  cutlet  and 
half  a  bottle  of  white  wine,  after  which  he  smoked  a  cigarette  until  it  was 
time  to  appear." 

1  Volume  ITT.  Chapter  XXVIT,  'TVfahdah's  Menus,"     '^at  and  Grow  Thin,"  by  Vance 
Thompson,  pub.  by  E.  P.  Dutton,  N.  Y. 


THE    DRY    CURE  561 

Wliile  discussing  food  aud  drink  for  actors  and  their  peculiar  idio- 
syncrasies, we  will  relate  the  dietary  habit  of  Mr.  Edmund  Kean,  who, 
according  to  ISmith/  "was  in  the  habit  of  adapting  the  kind  of  meat  he  ate 
to  the  part  he  had  to  play,  choosing  pork  for  tyrants,  beef  for  murderers, 
and  lamb  for  lovers."  This  may  seem  a  stretch  of  the  imagination,  "but 
it  may  indicate  that  there  are  subtle  differences  in  the  different  kinds  of 
meat  which  chemistry  has  not  enabled  us  to  detect,  but  which  are  yet  not 
Avithout  influence  upon  the  body." 

Ordinarily,  no  food  should  be  partaken  of  immediately  before  singing 
or  speaking,  but  a  good  meal  should  be  ingested  some  three  hours  before, 
which  should  be  somewhat  lighter  than  usual.  It  is  the  habit  of  many 
singers  and  speakers  to  refrain  from  food  prior  to  their  performance  or 
lecture,  and  to  partake  of  a  good  full  meal  soon  after.  According  to  Ruh- 
rali,  the  food  much  used  by  singers  is  the  so-called  "Jenny  Lind  soup," 
which  is  a  very  bland  potion,  and  does  not  impair  the  voice.  "It  is  made 
of  bouillon  and  sage,  to  which  are  added  the  yolks  of  two  eggs  and  half 
a  pint  of  cream  before  serving;  sugar  and  spices  are  added  according  to 
taste.  ]\Iany  prominent  singers  suck  an  orange,  while  others  chew  dried 
plums  immediately  preceding  their  performance."  During  the  interval 
between  performances,  a  singer,  like  any  other  professional  person,  should 
subsist  on  a  well-balanced  general  diet,  of  course  avoiding  irritating  foods. 
Singers  who  have  a  tendency  to  obesity  should  follow  the  dieting  and  exer- 
cise laid  down  in  Volume  Til,  Chapter  XTI,  for  the  treatment  of  this 
condition.  Alcoholic  liquors  and  strong  beverages  do  not  in  any  way  im- 
prove the  voice,  but  on  the  other  hand  may  exert  a  deleterious  effect,  and 
should  therefore  be  avoided.  Light  wines  and  beer  in  moderation  may 
usually  be  taken  with  impunity.  They  are  best  avoided,  however,  as  their 
continual  use  may  possibly  lead  to  the  formation  of  a  drinking  habit. 
Many  of  the  best  singers  are  of  the  opinion  that  smoking  is  injurious  to 
the  voice ;  on  the  other  liand,  many  famous  male  singers  are  habitual  users 
of  tobacco  and  are  rarely  seen  without  a  cigar  in  their  mouth. 

THE   DRY    CURE 

The  dry  cure  consists  in  withholding  fluid  from  the  diet,  giving  less 
and  less  each  day,  until  the  patient  takes  the  least  possible  amount  that 
will  sustain  life.  If  carried  to  this  extreme,  the  thirst  becomes  both  in- 
tolerable and  practically  unbearable,  and  as  a  result,  patients  strenuously 
rebel.    It  ha*?  been  found   from   actual  experiment  that  the  minimum 

» Dr.  Smith  in  his  work  on  Foods. 


562  SPECIAL   DIETS 

amount  of  water,  aside  from  that  contained  in  the  food,  which  patients 
can  bear  is  about  15  ounces  per  diem,  which  should  be  taken  during  the  in- 
tervals between  meals.  For  the  relief  of  the  insatiable  thirst  in  these  cases, 
various  measures  are  employed.  It  is  said  that  shipwrecked  sailors  in 
open  boats  have  relieved  their  thirst  by  immersing  their  bodies  in  salt 
water.  Under  ordinary  conditions,  however,  the  skin  is  not  capable  of 
absorbing  fluid  to  any  appreciable  extent,  but,  on  the  other  hand,  im- 
mersion in  water  prevents  evaporation  from  the  surface  of  the  body, 
which  to  some  extent  saves  a  loss  in  this  direction  and  thereby  satiates 
thirst.  Sucking  a  slice  of  lemon  or  drinking  water  acidulated  with  a 
few  drops  of  lemon  juice  or  vinegar  is  said  to  allay  thirst  better  than 
plain  water.  Barley  and  oatmeal  waters  are  occasionally  used  as  thirst 
quenchers. 

A  dry  diet  has  been  extensively  tried  by  German  clinicians,  especially 
in  cases  of  gastric  dilatation  and  in  chronic  effusion  in  the  joints  and 
in  peritoneal  cavity.  Many  types  of  disease  are  benefited  by  a  temporary 
restriction  in  the  daily  amount  of  fluids  consumed,  but  it  is  hardly  ever 
justifiable  to  resort  to  the  extreme  degree  recommended  by  enthusiastic 
devotees  of  the  dry  cure.  Thompson  says  that  patients  in  charge  of 
advocates  of  the  dry  cure  have  developed  fatal  cases  of  scurvy,  as  well 
as  cases  of  fever  with  a  temperature  running  sometimes  as  high  as  104°  F. 
A  temporary  restriction  in  the  quantity  of  fluid  is  of  dietetic  value  in 
gastric  dilatation,  chronic  serous  effusion,  flatulent  dyspepsia  due  to 
ingestion  of  sweets,  coffee  and  tea  in  too  large  amounts.  It  is  also  ad- 
visable in  some  cases  of  obesity  and  aneurism  to  withhold  fluids.  Con- 
sult the  Bellingham  and  Tufnell  Dietary,  previously  outlined  (see  page 
547). 

The  "dry  diet  cure,"  says  Albu(32),  "is  as  old  as  the  Greeks,  but  was 
revived  by  Schroth  in  his  so-called  semmelJcur,  and  has  achieved  some  no- 
toriety in  Europe,  where  several  'institutes'  have  been  established  for  its 
practice."  The  alimentation  consists  of  the  consumption  of  five  or  six 
dry  rolls  in  the  course  of  a  day,  while  liquids  are  entirely  restricted  for 
a  period  varying  from  five  to  six  days.  The  method  is  so  rigorously  dry 
that  many  patients  find  it  diflicult  to  endvire,  saying  the  "cure  is  worse 
fhan  the  disease."  Boiled  vegetables  are  allowed  for  dinner,  otherwise 
nothing  is  given  but  dried  bread.  Thirst  becomes  so  extreme  after  three 
or  four  days  that  the  patient  is  allowed  hot  wine  freely  as  a  thirst 
quencher,  after  which  the  quantity  of  fluid  is  again  cut  down  to  two 
glasses  a  day  until  the  patient  is  again  obliged  to  have  moi-e  fluid.  Jergu- 
son  found  Schroth's  diet  useful  in  the  treatment  of  plethora  and  perito- 


THE    YOLK   CURE  663 

neal  effusions.  He  observed  that  abstinence  from  fluid  caused  great  dis- 
tress, so  he  modified  the  diet  by  giving  from  one-third  to  two-thirds  of  a 
pound  of  lean  beef  with  bread  and  light  red  wine.  Sweiten  found  the  dry 
diet  useful  in  the  treatment  of  dilatation  of  the  stomach.  Albu(32)  found 
the  dry  diet  valuable  in  the  dietetic  treatment  of  renal  and  cardiac  dropsy. 
The  patient  on  returning  to  the  accustomed  diet  must  be  cautioned  to  do 
80  with  great  care,  taking  food  only  in  very  small  portions,  a  very  little 
at  a  time.  A  rapid  gain  in  weight  will  be  noted,  which  is  attributed  in 
part  to  the  restoration  of  water  to  his  tissues.  Bartels  observed  an  increase 
in  urea  which  was  greatest  immediately  after  the  treatment.  The  high 
temperature  accompanying  this  method  of  treatment  is  explained  by  the 
fact  that  but  little  water  is  evaporated  from  the  lungs  and  skin,  causing 
the  body  heat  to  be  retained.  As  has  been  suggested,  the  dry  diet  cure 
has  in  many  instances  been  carried  to  the  verge  of  starvation  with  extreme 
prostration,  fever  and  fatal  cases  of  scurvy,  and  has  little  or  nothing  to 
recommend  it. 

THE  YOLK   CURE 

Egg  yolks  as  an  addition  to  the  diet  of  the  underfed  and  badly  nour- 
ished are  often  of  the  greatest  service  in  a  variety  of  forms  of  faulty 
nutrition.  In  certain  instances  in  which  there  is  inability  to  assimilate 
the  entire  eg;g,  the  yolks  are  of  great  value.  A  daily  portion  of  from  ten 
to  forty  yolks  may  be  added  to  the  customary  diet.  The  white  of 
the  egg  consists  of  a  solution  of  protein  shut  up  in  the  interior  of  many 
millions  of  cells.  The  protein  of  the  white  of  egg  is  called  "egg-albumin." 
The  yolk  is  a  storehouse  of  nutriment  for  the  young  chick,  and  conse- 
quently has  a  very  different  composition  from  the  white.*  It  contains 
much  less  water  and  more  solids,  among  the  latter  being  a  large  proportion 
of  fat.  The  general  composition  of  the  white  and  yolk  is  contrasted  in 
the  table  on  page  351,  to  which  the  reader  is  referred.  The  palmitin, 
stearin  and  olein  are  simply  fats  such  as  we  have  already  encountered 
in  butter  and  have  the  same  nutritive  value  as  these.  Their  presence  in 
the  form  of  an  emulsion  in  the  yolk  makes  them  more  easily  digested, 
which  renders  the  yolk  particularly  suited  to  individuals  whose  nutrition 
is  below  par  and  who  do  not  do  well  on  ordinary  diets. 

Stern  (88)  gives  the  following  simple  dietary  for  a  patient  whose  nor- 
mal weight  should  be  140  pounds,  but  who,  owing  to  debilitation,  weighs 
only  110  pounds: 


1  Ffee  Analj'sis  of  Eggs,  Volume  T,  Chapter  XII,  p.  351. 


564 


SPECIAL   DIETS 
DIETARY  FOR  DEBILITY 


Number 
of  yolks 

Calories  in 
the  yolks 

Total  num- 
ber of  calories 

Breakfast: 

250   c.c.    skim    milk    with    4   yolks; 
30  grams  wheat  toast 

4 

2 

4 

3 
1 

1 

200 

100 
200 

150 
50 

50 

200 
75 

Forenoon  Lunch: 

Cup  of  coffee,  2  yolks 

100 

Dinner: 

One  plate  of  soup,  4  yolks; 
beef  (very  lean),  150  grams; 
30  grams  wheat  toast 

225 

125 

75 

Afternoon  Lunch: 

25  c.c.  skim  milk,  30  c.c.  whiskey,  3 
yolks 

370 

Supper: 

Porridge  of  farina  or  rice,  100  grams; 
1  yolk,  skim  milk; 
apple  sauce,  75  grams 

350 
30 

At  Bedtime: 

Night  cap  (90  c.c,  hot  water,  10  c.c. 
whiskey,  1  yolk,  teaspoonful  gran- 
ulated sugar) 

110 

15 

750 

1660 

If  it  should  be  deemed  expedient  to  continue  this  dietary  over  any 
great  period  of  time,  the  dishes  in  which  the  yolks  of  eggs  are  incorporated 
should  be  varied  as  much  as  possible.  The  great  richness  of  yolk  of  egg 
in  fat  and  lime  salts  and  in  organic  compounds  of  phosphorus  and  iron 
make  it  pecmliarly  valuable  as  an  adjunct  to  the  dietary  of  infants  and 
young  children,  especially  those  which  are  suffering  from  rickets,  mal- 
nutrition, athrepsia,  etc.,  for  it  is  these  very  compounds  which  the  child 
needs,  especially  the  rickety  child. 


MILK  CURES 

Kumiss  Cure. — Kumiss  is  an  agreeable  milk  preparation  readily 
digested  and  easily  absorbed.  It  has  been  made  for  many  hundreds  of 
years  by  tribes  of  nomadic  Tartars  in  eastern  Europe  from  mare's  milk. 
A  substitute  for  it  made  from  cow's  milk  is  called  'Tcephir,"  but  this  is  not 
genuine  kumiss.  The  general  properties  of  kumiss  and  kephir  are  given 
in  Volume  I,  Chapter  XTI.  The  so-called  kumiss  in  this  country  is  really 
kephir.  Kumiss  contains  from  1  to  2  per  cent  of  alcohol  and  efPervesces 
on  opening  the  bottle.    It  is  more  easily  digested  and  more  completely  ab- 


MILK    CURES  565 

sorbed  than  ordinary  milk  and  can  be  taken  in  large  amounts.  It  is  mildly 
diuretic  and  gently  laxative,  and  like  other  milk  cures,  lessens  intestinal 
putrefaction  by  virtue  of  the  lactic  acid  which  it  contains.  As  a  cure,  on  an 
average  from  two  to  four  quarts  are  taken  daily,  but  much  larger  quantities 
are  taken  in  Itussia  at  resorts  where  this  method  is  in  vogue.  Ordinarily, 
kumiss  is  ordered  in  combination  with  nourishing  food  of  a  protein  nature, 
carbohydrates,  fruits  and  saccharine  foods  being  specially  restricted.  If 
diarrhea  becomes  annoying,  it  is  well  to  add  lime  water  to  the  kumiss.  In 
Ilussia,  kumiss  is  largely  employed  in  the  treatment  of  pulmonary  tuber- 
culosis, but  its  principal  value  in  this  country  lies  in  the  fact  that  it  is  a 
valuable  liquid  food  which  many  patients  can  take,  with  whom  plain  milk 
and  its  other  modifications  disagree.  The  peculiar  qualities  of  kumiss  ren- 
der it  a  most  useful  foodstuff  in  the  dietetic  treatment  of  many  stomach 
and  bowel  derangements.  In  the  section  dealing  with  milk  will  be  found 
a  complete  description  of  the  kephir  granules  and  directions  for  making 
kephir.  The  analytical  table,  page  568,  gives  the  analysis  of  genuine 
kumiss  and  kephir  from  mare's  milk  and  the  home-made  product  from 
cow's  milk,  as  well  as  Egyptian  youghourt  and  old-fashioned  buttermilk. 
It  will  be  observed  that  the  total  protein  is  slightly  less  in  kumiss  and 
kephir  than  in  mare's  and  cow's  milk  respectively.  In  kumiss,  the  fat 
is  practically  the  same  as  in  mare's  milk.  On  the  other  hand,  the  per- 
centage of  fat  in  kephir  is  naturally  lower  than  cow's  milk,  owing  to  its 
partial  removal  before  fermentation  is  begun. 

Considering  kephir  in  the  light  of  what  we  have  already  learned  as  to 
the  digestibility  of  cow's  milk,  we  will  easily  perceive  that  the  process  of 
fermentation  must  render  the  latter  much  more  easily  digested  and  ab- 
sorbed than  it  is  in  its  natural  state.  The  casein  of  cow's  milk  is  the  great 
obstacle  to  easy  digestion,  but  in  kephir  it  is  readily  attacked  by  the  di- 
gestive juices;  in  fact,  it  is  already  partly  digested  when  ready  to  serve. 
In  the  light  of  the  facts  before  us,  it  is  not  difficult  to  understand  why 
enormous  quantities  of  kumiss  and  kephir  can  be  disposed  of  in  the  process 
of  metabolism  without  difficulty.  We  read,  for  instance,  that  the  healthy 
dweller  on  the  Steppes  is  capable  of  consuming  from  three  to  four  gallons 
of  kumiss  on  a  hot  summer  day,  while  a  debilitated  consumptive  can  take 
with  impunity  the  contents  of  ten  large  champagne  bottles  in  twenty-four 
hours  (34). 

Kumiss  and  kephir 'are  practically  identical  in  composition,  but  in 
each  the  actual  percentages  depend  somewhat  on  the  duration  of  the  fer- 
mentation process. 

136 


566  SPECIAL    DIETS 

COMPOSITION  OF  SOUR  MILK:  PERCENTAGES' 


Composition 

Butter- 
milk 

Kephir: 

Goat's 

Milk 

Kumiss: 

Mare's 

Milk 

Egyptian 

Youghourt : 

Cow's 

Milk 

Home-made 

Kumiss: 

Cow'sMilk, 

Sugar,  and 

Yeast 

Home-made 
Youghourt: 
Cow's  Milk 
and  Cul- 
tures of 
Bacilli 

Water 

Casein ^ 

Albumin I- 

Peptones J 

Fat 

90.93 

3.01 

1.2 
3.3 
0.0 
0.3 

87.33 

2.75 

.46 

.26 

3.08 

2.56 

1.75 

1.25 

.65 

.56 

89.19 
1.73 
.55  \ 

.25 ; 

2.05 
2.25 
1.50 
1.15 
.75 
.26 

47.44 
16.00 

3.76 

16.00 
14.00 

2.25 

2.80 

88.00 
2.56  \ 

.32  / 

.25 
1.25 
3.67 
1.60 

.61 
1.50 

.75 

89.00 

3  to  3.25 

.25  to    .46 
3.0   to  3.5 

Sugar 

1.25  to  2.0 

Alcohol.    . 

.21 

Lactic  acid 

Carbonic  acid  gas 
Salts 

.5   to  1.0 

1.0   to  1.25 

.20 

1  Tliis  table  is  derived  from  analyses  by  Atwater,  Hammarston,  Fleischmann, 
Hartier,  Sharp,  Stange,  Dujardin-Beaumetz,  Wanklyn,  Richmond,  etc. 

The  kumiss  cure  is  suitable  for  gastric  and  pulmonary  catarrh.  Some- 
times it  is  beneficial  in  anemia,  malnutrition  and  convalescence  from  ill- 
ness; mental  hebetude  and  bodily  languor  and  excitement  of  the  sexual 
organs  have  been  observed  as  sequels  of  the  treatment. 

Matzoon  Cure — Matzoon  is  a  fermented  milk  product  manufactured 
with  the  aid  of  a  lactic  acid  ferment  obtained  from  Syria.  It  is  a  sour, 
thick  substance,  more  of  the  consistency  of  cream  than  kumiss.  Unlike 
kumiss,  it  does  not  contain  alcohol  or  carbonic  acid  gas,  and  is  taken  in 
smaller  amounts.  It  is  very  agreeable,  very  readily  digested  and  highly 
nutritious. 

Buttermilk  Cure — This  cure  depends  chiefly  on  two  considerations: 
first,  the  low  fat  content,  which  makes  it  of  great  value  where  fat  is  not 
well  borne;  second,  the  presence  of  lactic  acid  bacilli.  The  lactic  acid 
bacilli  contained  in  buttermilk  seem  to  possess  the  properties  of  driving 
out  offending  bacteria,  especially  those  causing  fermentative  and  intes- 
tinal conditions,  and  to  reestablish  a  more  or  less  bacterial  flora  in  the  in- 
testinal tract.  Of  late  years  whole  milk  which  has  been  inoculated  with 
lactic  acid  bacilli  is  frequently  substituted  for  buttermilk,  but  it  should 
be  borne  in  mind  that  this  artificial  preparation  should  not  be  used  in 
diseased  conditions  due  to  fat  indigestion. 

Of  late  years  buttermilk  and  similar  preparations  have  been  very  ex- 
tensively used  by  the  laity  in  the  treatment  of  a  great  many  different 


MILK    CUKES  567 

ailments.  Buttermilk  as  an  aliment  has  certain  uses  in  the  dietary,  and 
the  following  conditions,  in  which  it  is  of  practical  value,  are  worthy  of 
note : 

(a)  In  conditions  where  fat  is  not  metabolized,  especially  in  acute  or 
chronic  fat  diarrhea. 

(b)  In  infants  and  children  sutiering  from  marasmus  or  general  mal- 
nutrition due  to  fat  diarrhea  or  indigestion. 

(c)  In  chronic  dyspepsia  accompanied  by  constipation. 
{d)   In  the  fermentative  diarrheas. 

(e)  In  typhoid  and  other  debilitating  fevers  where  ordinary  milk  is 
not  well  borne. 

(/)  As  an  adjunct  to  the  diet  after  surgical  operations,  especially  if 
the  patient  does  not  bear  plain  milk  well. 

There  is  nc  beverage  so  wholesome  as  good  buttermilk  fresh  from  the 
churn.  Its  nutritive  value  is  considerable,  an  ordinary  glassful  yielding 
about  as  much  nourishment  as  two  ounces  of  bread.  It  is  chiefly  worthy 
of  notice  as  being  an  economical  source  of  protein.  In  respect  to  this  con- 
stituent, it  is  not  one  whit  inferior  to  ordinary  milk,  and  yet  buttermilk 
•  in  agricultural  districts  is  usually  fed  to  pigs.  There  can  be  no  question 
that  this  IS  a  deplorable  waste  of  a  very  valuable  food.  When  used  in 
large  quantities,  buttermilk  possesses  diuretic  properties  which  may  be  a 
slight  disadvantage  in  health,  but  would  rather  enhance  its  value  than 
otherwise  in  many  diseased  conditions.  The  chief  point  in  which  butter- 
milk differs  from  whole  milk  is  its  poverty  in  fat.  In  this  respect  it  re- 
sembles skim  milk.  The  loss  of  milk  sugar  from  the  formation  of  lactic 
acid  is  so  small  as  to  be  of  no  significance.  The  ease  with  which  butter- 
milk can  be  digested  has  led  to  its  being  recommended  as  a  food  for  in- 
fants (.35). 

Sour  Milk  Cure. — Many  changes  take  place  in  milk  during  the  process 
of  souring.  The  sugars  to  a  large  extent  are  replaced  by  lactic  acid,  alco- 
hol and  carbonic  acid  gas ;  the  casein  is  partly  broken  down  and  precipi- 
tated to  1  very  fine  division  and  partly  predigested  while  the  fats  and  salts 
remain  practically  unchanged. 

The  analyses  on  page  568  give  a  pretty  fair  summary  of  the  changes 
that  occur  during  the  process  of  souring. 

When  the  fermentation  process  of  kumiss  and  kephir  is  allowed  to  go 
for  only  twelve  hours,  it  is  slightly  sour  and  somewhat  resembles  milk  in 
taste  and  appoarnnce.  When  fermented  for  twenty-four  hours,  some  of 
the  casein  will  be  dissolved,  and  as  a  result,  the  kumiss  will  be  thinner 
but  sourer.     If  the  fermentation  process  is  allowed  to  continue  another 


568 


SPECIAL    DIETS 


ANALYSES  OF  CHANGES  OCCURRING  IN  THE  FERMENTATION 

OF  MILK 


Lactic 

Acid, 

Per  cent 


Kumiss  (1) 

Kephir  (2) 

Mare's  Milk  (3) 
Cow's  Milk  (4) . 
Buttermilk  (5).. 


Protein, 

Sugar, 

Fat, 

Salts, 

Alcohol, 

Per  cent 

Per  cent 

Per  cent 

Per  cent 

Per  cent 

2.2 

1.5 

2.1 

0.9 

1.7 

3.1 

1.6 

2.0 

0.8 

2.1 

2.6 

5.5 

2.5 

0.5 

3.3 

4.8 

3.6 

0.7 

3.8 

3.3 

1.2 

0.6 

0.9 
0.8 


0.3 


day,  it  will  be  still  thinner  and  sonrer,  and  more  thoroughly  charged  with 
carbonic  acid  gas.  The  percentage  of  alcohol  varies  from  1.5  at  the  end 
of  12  hours  to  as  much  as  3.0  per  cent  at  the  end  of  36  hours. 

The  sour  milk  cure  is  extensively  used  in  Turkey,  Servia,  Bulgaria 
and  neighboring  countries.  The  Bacterium  caucasicus,  or  Bulgarian 
bacillus,  is  the  most  active  of  the  lactic  acid  ferments,  and  in  these  coun- 
tries it  is  extensively  used  to  sour  milk  for  a  beverage.  This  Bacillus  bul- 
garicus  when  introduced  into  the  intestinal  tract  in  large  numbers  will 
check  the  growth  of  offending  bacteria  and  greatly  lessen  the  number  of 
other  organisms. 

During  recent  years,  a  valuable  method  of  treatment  by  means  of 
soured  milk  and  other  methods  of  administering  selected  lactic  germs  has 
been  brought  to  the  notice  of  the  profession  by  the  distinguished  French 
bacteriologist,  Eli  Metchnikoff,  of  the  Pasteur  Institute,  Paris.  The 
Metchnikoff  method  has  of  late  years  become  a  fashionable  craze,  and,  as 
is  usual  when  a  new  therapeutic  method  is  introduced,  exaggerated  claims 
have  been  made  in  its  favor.  While  our  knowledge  of  this  method  of 
treatment  is  by  no  means  complete,  yet  clinical  experience  has  abun- 
dantly proven  that  it  is  a  real  advance  in  trophotherapeutics,  and  we  will 
therefore  give  a  short  account  of  it  as  laid  down  by  Metchnikoff.  It  is 
imnecessary  to  state  here  that  this  food  exerts  an  influence  on  the  normal 
bacterial  content  present  in  the  intestinal  canal. 

This  dependence  of  intestinal  microbial  growths  on  the  nature  of  food  is  due 
to  the  fact  that  certain  bacilli  secrete  substances  which  render  the  soil  unsuitable 
for  others,  so  that  by  selecting  an  organism  which  is  innocuous  to  human  beings, 
we  are  enabled  to  destroy  active  germs  productive  of  injurious  effects.  In  order 
to  attain  this,  we  must  secure,  if  possible,  an  antiseptic  mechanism  which,  once 
started,  will  maintain  its  effect,  and  this  can  only  be  accomplished  hy  the  services 
of  a  living  organized  ferment.  It  is  well  known  that  lactic  acid  is  a  powerful 
anti-putrefactive  agent.     When  milk  turns  soui:,  that  is  to  say,  when  the  milk 


MILK    CURES  569 

sugar  has  undergone  lactic  fermentation  with  the  formation  of  lactic  acid,  it  can 
then  resist  putrefaction  for  a  long  time. 

The  knowledge  of  the  action  of  lactic  acid  in  souring  milk  induced 
Metchnikoff  to  employ  cultures  of  the  lactic  germs  in  order  to  produce 
nascent  lactic  acid  just  where  its  action  is  most  needed.  The  culture  prod- 
uct by  wliich  these  results  were  secured  is  known  as  "lacto-bacilline." 

During  the  ingestion  of  meals,  fresh  microorganisms  attached  to  un- 
cooked food  find  their  way  into  the  intestinal  tract,  and  these  invaders 
intensify  the  effect  of  preexisting  colonies  in  inducing  putrefaction  of  the 
intestinal  contents  and  noxious  fermentations,  particularly  butyric  acid 
fermentation.  The  lactic  acid  content  in  sour  milk  can  prevent  butyric  fer- 
mentation and  putrefaction,  both  of  which  are  capable  of  causing  various 
disorders  in  the  human  organism,  and  sour  milk  finds  its  greatest  efficacy 
in  hindering  decomposition  changes  in  the  alimentary  canal.  In  endeav- 
oring to  combat  intestinal  putrefaction,  instead  of  prescribing  lactic  acid, 
which  is  oxidized  or  excreted  by  the  kidneys,  it  is  better  to  introduce  the 
fresh  living  lactic  germs  into  the  digestive  tract,  either  in  the  form  of  but- 
termilk, lacto-bacilline  powder,  tablets  or  soured  milk.  The  lactic  germs 
on  reaching  the  intestines  multiply  with  great  rapidity,  and,  depending 
upon  the  supply  of  sugar,  which  is  necessary  for  their  maintenance,  they 
set  free  lactic  acid  that  permeates  the  intestinal  contents,  inhibiting  putre- 
faction and  all  irregular  fermentation.  Milk,  in  order  to  undergo  thor- 
ough lactic  acid  fermentation,  must  have  planted  in  it  the  organized  fer- 
ments— the  living  microbes — cultures  of  the  Bulgarian  bacillus,  which 
may  be  added  in  the  form  of  lacto-bacilline  powder  or  tablets,  which  is  a 
most  active  producer  of  lactic  acid,  coagulating  milk  within  a  few  hours 
and  curdling  it  without  the  assistance  of  any  other  organism.  When  milk 
is  treated  by  this  method  a  very  large  proportion  of  the  casein  is  rendered 
soluble  and  a  still  greater  percentage  of  the  phosphate  of  lime  has  its  solu- 
bility similarly  increased.  * 

Lactic  acid  therapy  is  indicated  in  certain  cases  of  chronic  intestinal 
catarrh,  pernicious  anemia,  subacute  and  chronic  nephritis,  rheumatism, 
gout  and  diabetes.  This  treatment  is  especially  indicated  and  of  great 
value  in  cases  of  intestinal  toxemia,  intestinal  intoxication  resulting  from 
the  abnormal  putrefaction  of  proteins;  but  it  is  of  little  value  in  putre- 
factive conditions  resulting  from  carbohydrate  fermentation. 

Milk   Cure The  milk  cure,   or  an  exclusive  milk   diet,   has  been 

recommended  for  various  diseased  conditions.  It  is  carried  out  systemat- 
ically at  certain  health  resorts  in  different  countries,  more  especially  in 
Switzerland  and  Germany.    The  cure  consists  of  the  consumption  of  ordi- 


570  •  SPECIAL   DIETS 

nary  milk  in  its  pure,  undiluted,  uncooked  condition.  To  obtain  the  best 
results,  the  milk  should  be  fresh  and  warm,  just  as  it  is  drawn  from  the 
cow,  since  in  this  condition  it  is  almost  entirely  free  from  bacteria  and 
contains  the  greatest  proportion  of  enzymes,  and  possesses  the  highest  bac- 
tericidal capacity.  The  milk  cure  is  exceedingly  ancient  and  is  of  great 
value  in  the  treatment  of  tuberculosis,  nervous  disorders  and  many  condi- 
tions of  debility  and  malnutrition.  Its  peculiar  value  lies  in  that  milk 
is  easily  digested,  comparatively  unirritating,  and,  when  used  exclusively, 
tends  to  lessen  abnormal  fermentation  in  the  intestinal  tract.  It  is  the 
food  par  excellejice  for  the  infant,  as  it  supplies  the  precise  need  for 
growth  and  development. 

The  application  of  the  milk  cure  is  carried  out  with  the  best  results 
in  rural  districts  or  places  where  cattle  are  kept  for  the  purpose.  The 
milk  should  be  raw  or  at  a  temperature  of  the  atmosphere,  and,  whenever 
possible,  it  should  be  conveyed  direct  from  the  cow  to  the  patient  in  the 
shortest  possible  time  to  avoid  the  loss  of  enzymes  and  anti-bodies  con- 
tained in  it.  Even  in  the  winter  months,  it  should  not  be  heated  above 
140°  F.  because  lecithin,  the  vitamines,  and  other  important  bodies  are 
destroyed  by  a  temperature  beyond  this  degree.  The  vitamines  contained 
in  milk  are  of  the  greatest  importance.  This  subject  has  already  been 
covered  in  the  section  dealing  with  milk  in  the  chapters  on  Animal  Foods, 
to  which  the  reader  is  referred.*  Too  much  emphasis  cannot  be  laid  on 
the  fact  that  milk  should  be  taken  raw  and  as  soon  after  being  drawn 
from  the  cow  as  circumstances  will  permit.  It  should  not  be  forgotten 
that  the  bactericidal  power  of  milk  diminishes  very  rapidly  after  it  is 
drawn,  and  a  few  hours  after  milking  it  is  practically  mZ.  It  is  true  that 
boiling  milk  destroys  bacteria,  and  until  a  few  years  ago  it  was  customary 
to  recommend  that  all  milk  should  be  boiled  for  two  or  three  minutes 
before  being  ingested.  In  the  light  of  recent  knowledge,  it  is  considered 
that  pure  and  wholesome  milk  should  not  be  subjected  to  heat,  for,  as  just 
pointed  out,  a  temperature  beyond  140°  F.  destroys  lecithin  and  other 
important  bodies,  including  the  vitamines. 

In  order  to  supply  the  economy  with  sufficient  protein  to  yield  the 
requisite  amount  of  energy,  a  considerable  quantity  of  milk  must  be  con- 
sumed. Good  whole  milk  of  average  quality  has  a  heat  value  of  325  calo- 
ries per  pint.  If  milk  is  taken  in  large  quantities,  digestive  derangements 
are  liable  to  occur  from  the  formation  of  large  curds  in  the  stomach :  if 
these  pass  into  the  small  intestines  they  are  apt  to  be  matted  and  as  n 


1  Ser  Volume  T,  Chapter  XIT ;  Volume  IT,  Chapter  TX. 


MILK    CURES  571 

result  offer  much  resistance  to  the  digestive  enzymes  and  may  cause  diar- 
rhea, on  the  one  hand,  or  constipation  with  dry  feces  on  the  other. 

When  milk  is  used  as  the  only  article  of  diet,  it  should  be  given  at 
iirst  in  quantities  not  to  exceed  half  a  glass  every  second  hour ;  after  two 
or  three  days  two-thirds  of  a  glass  may  be  given  at  a  time,  and  later,  a 
whole  glass  or  eight  ounces.  The  milk  should  be  drunk  very  slowly,  in  fact 
it  should  be  sipped ;  it  should  be  taken  at  regular  intervals  during  the  day 
and  two  or  three  times  at  night.  As  many  as  twelve  glasses,  eight  ounces 
each,  should  be  prescribed  during  the  twenty-four  hours.  Constipation 
is  not  an  unfavorable  indication  when  taking  the  milk  cure,  but  means 
that  the  milk  is  well  digested  and  well  absorbed.  It  can  be  counteracted 
by  mild  laxatives.  On  the  other  hand,  vomiting  and  diarrhea  indicate 
digestive  disturbances  and  malassimilation.  At  the  beginning  of  the  milk 
cure,  patients  often  lose  flesh,  but  when  taking  the  maximum  quantity, 
they  hold  their  own,  or  may  even  gain  in  flesh.  Milk  is  one  of  the  most 
digestible  foods.  Three  liters,  equal  to  about  five  pints,  should  be  taken 
daily.  This  amount  would  supply  an  adult  with  sufficient  energy  for  the 
performance  of  light  work,  yielding  about  2,050  calories,  which  is  neces- 
sary for  the  maintenance  of  nitrogen,  equilibrium.  When  less  than  this 
quantity  is  consumed,  most  people  show  loss  of  nitrogen. 

The  milk  cure  is  reconmiended  by  physicians  for  several  reasons: 
(a)  to  maintain  the  nitrogen  balance;  (6)  to  sustain  the  patient's 
strength;  (c)  to  produce  gain  in  body  weight,  and  (d)  sometimes  to 
unload  the  system  of  superfluous  weight,  water,  purins,  complex  amides, 
extractive  nitrogenous  matter,  etc.,  which  are  considered  deleterious  to 
health.  The  object  of  Weir  Mitchell's  treatment(36)  of  forced  feeding 
is  to  cause  a  gain  of  protein  for  the  benefit  of  enfeebled,  nervous  and  mus- 
cular systems,  which  is  supplied  from  a  milk  diet  slowly  increasing  from 
two  to  as  much  as  five  pints  of  milk  by  the  end  of  the  eighth  day.  This 
subject  has  already  been  considered  in  the  present  chapter  (page  549). 

When  a  milk  cure  is  prescribed,  nothing  but  milk  is  allowed  for  the 
first  two  weeks,  unless  it  becomes  necessary  to  alter  the  flavor  or  modify 
the  constituents  of  milk.  The  flavor  may  be  varied  by  adding  small  quan- 
tities of  salt,  celery  salt,  burnt  sugar  or  extract  of  malt.  If  there  is  a 
tendency  to  fonn  large  curds,  this  may  be  prevented  by  the  addition  of 
lime  water,  barley  water,  oatmeal  water  or  malt  extract.  If  there  is  a 
tendency  to  nausea,  it  may  be  prevented  by  the  above  modifications.  If 
flatulence  becomes  anuoving,  it  can  bo  prevented  by  the  addition  of  Vichy 
water,  a  little  salt  or  bicnrboiiate  of  soda.  A  patient  on  a  strict  milk  diet 
may  complain  of  a  thick,  white-yellowish  pasty  coat  on  tlie  tongue,  and 


572  SPECIAL    DIETS 

a  disagreeable  mawkish  taste  in  the  mouth.  As  previously  stated,  the 
beginning  of  the  milk  cure  is  in  reality  a  period  of  starvation  or  under- 
feeding, as  a  patient  in  bed  at  absolute  rest  requires  1,600  calories  of 
energy  daily,  which  would  require  the  ingestion  of  four  pints  of  milk. 
Underfeeding  may  cause  restlessness  and  insomnia.  Casein  indigestion 
from  excess  of  fat  or  want  of  freshness  in  the  milk  may  lead  to  diarrhea. 
The  urine  is  increased  in  quantity,  while  the  excretion  of  uric  acid  and 
purin  bodies  is  lessened ;  but  the  quantity  of  urea  is  in  proportion  to  the 
digested  casein,  and  the  urine  ofttimes  has  a  greenish  tinge.  Indican  and 
similar  compounds  disappear  from  the  urine.  As  the  quantity  of  milk 
consumed  increases,  the  system  becomes  satisfied,  insomnia  complained  of 
at  the  beginning  is  replaced  by  drowsiness,  which  is  a  hopeful  sign  when 
the  tongue  is  clear  and  the  pulse  good.  At  the  beginning  of  the  third 
week,  or  after,  the  patient  should  be  gaining  in  flesh,  the  appetite  will 
return,  and  a  desire  for  solid  food  will  be  increased.  In  another  fort- 
night a  little  fish  or  fowl  may  be  allowed  in  the  middle  of  the  day,  and 
at  the  end  of  one  month  a  gradual  return  to  the  ordinary  diet  is  advised. 
Skim  Milk  Cure — The  skim  milk  cure  is  employed  in  the  dietetic 
treatment  of  valvular  disease,  nephritis,  gout,  obesity,  chronic  bronchitis 
and  emphysema.  It  must  not  be  overlooked  that  skim  milk  as  an  aliment 
only  partially  supplies  the  energy  expended  by  the  body,  that  it  in  reality 
is  a  system  of  underfeeding,  and  where  it  is  the  only  aliment,  its  continued 
use  will  reduce  the  strength,  weight  and  vitality  of  the  patient.  One 
author  *  reports  200  cases  in  which  he  employed  skim  milk  as  a  diet  for 
unloading  the  system  generally,  more  especially  the  vascular  system.  When 
this  method  of  treatment  is  instituted,  it  is  recommended  that  the  quantity 
allowed  should  be  from  one-fourth  to  one-half  a  pint  of  skim  milk  three 
or  four  times  a  day,  sipped  slowly.  The  milk  should  be  fresh  and  ob- 
tained twice  daily.  Donkin  is  quoted  as  having  had  considerable  experi- 
ence in  the  treatment  of  disease  by  the  skim  milk  diet  and  highly  recom- 
mends it  in  diabetes,  beginning  with  four  pints  daily  and  increasing  some- 
times to  a  maximum  of  twelve  pints.  Lenhartz  has  systematically  em- 
ployed the  skim  milk  diet  for  many  years  past  in  the  treatment  of  heart 
disease  with  failure  from  compensation.  Under  his  method,  the  patient 
is  placed  in  bed  absolutely  at  rest  for  the  first  five  days  and  is  allowed 
seven  ounces  of  milk  four  times  a  day.  During  the  next  six  days  he  is 
allov^ed  one  ef^g,  some  zwieback  in  addition  to  his  daily  allowance  of  milk, 
and  a  little  later  some  minced  meat  and  vegetables  are  added,  so  that 


1  Carell,  in  1865,  quoted  by  Tibbies. 


MILK    CURES  573 

about  the  twelfth  day  there  is  a  gradual  return  to  a  full  mixed  diet.  Leu- 
hartz  claims  that  the  failure  of  relief  with  this  treatment  is  to  be  regarded 
as  a  sign  of  advanced  degeneration  of  the  cardiac  tissue. 

Whey  Cure. — The  whey  cure  has  been  extensively  used  at  the  various 
springs  and  baths  in  the  mountainous  districts  of  Germany  and  Switzer- 
land, notably  Ems  and  Reichenhall  and  those  of  the  alkaline  waters,  which 
are  frequently  mingled  with  the  whey  and  drunk  either  warm  or  cold. 
The  treatment,  like  that  of  the  dry  diet  previously  described,  is  rigorous 
and  consists  in  confining  the  patient's  daily  alimentation  largely  to  the  use 
of  twenty  or  more  ounces  per  diem  of  fresh  milk  whey. 

The  principles  of  this  method  of  treatment  are  quite  similar  to  those 
of  the  milk  cure,  but  in  whey  the  casein  of  the  milk  has  been  artificially 
removed  by  the  precipitation  of  casein  by  rennin,  as  in  cheese  making. 
Whey  is  a  thin  semi-transparent  liquid  of  a  pleasing  sweetish  taste.  Ac- 
cording to  Atwater  it  has  the  following  percentage  composition: 

Per  cent 

Protein 1        to  1.25 

(Casein,  Albumin) 

Fat 0.3      to  0.5 

Sugar 3.5      to  5.0 

Mineral  matter 0.103 

Lactic  acid 0.33 

Fuel  value,  145  calories  per  pint. 

Whey  is  a  nutritious  beverage  useful  in  the  dietetic  treatment  of  dis- 
ease, particularly  as  a  diluent  of  cow's  milk  for  feeding  infants.  It  is 
easily  digested,  is  bland  and  unirritating  to  the  stomach,  but  it  may  cause 
flatulence  and  acidity  in  people  who  are  subject  to  these  troubles. 

By  referring  to  the  section  dealing  with  milk  in  the  chapter  on  Animal 
Foods,^  a  full  and  explicit  consideration  of  this  subject  will  be  found. 
The  whey  cure  is  advocated  in  some  cases  of  chronic  indigestion  and  ab- 
dominal plethora.  It  is  also  used  in  the  treatment  of  Bright's  disease  and 
chronic  catarrhal  conditions  of  the  alimentary  canal.  Thompson (37)  rec- 
ommends it  particularly  for  chronic  dyspepsia  and  chronic  irritable  cough 
accompanying  catarrh  of  the  respiratory  mucous  membranes.  In  abdom- 
inal plethora  as  much  as  eight  to  ten  tumblerfuls  may  be  added  daily  to 
a  diet  of  fruit  and  vegetables.  It  is  often  combined  with  the  grape  diet, 
described  on  page  546.  When  taken  in  large  amounts,  whey  has  a  tend- 
ency to  produce  diarrhea. 


1  fiee  Voliiiiio  T,  riiajitpr  XTT,  p.  307, 


574  (SPECIAL    DIETS 


KEFERENCES 


1.  HuPE,  Ferdinand.     JNlodeni  Vegetarianisms,  Berlin,  1900. 
Albu,  Albert.    Die  Vegetarisclie  Diat,  Leipzig,  1902. 

2.  PoRPiiYRE.      (lieally  named  ^lalk,  born  Tyre,  in  233  a.d.,  taught 

philosophy  at  Kome,  where  he  died  in  304. )     Published  Life  of 
Pythagoras. 

3.  TiBBLES,  William.     Food  in  Health  and  Disease. 

4.  Neumann,  W.     Essays  on  Diet,  p.  64. 

5.  Hutchison.     Food  and  Dietetics,  p.  109. 

6.  Caultey,  Edmund.     Sutherland's  System  of  Diet  and  Dietetics. 

7.  Waylen.     Brit.  Med.  J.,  1900,  vol.  i,  p.  37. 

8.  Jaffa,  M.  E.     U.  S.  Dept.  of  Agric.  Exper.  Sta.  Bull.  No.  132. 

9.  Wait.    U.  S.  Dept.  of  Agric,  Bull.  No.  187. 

10.  RoTciT,  T.  Morgan.     Practical  Pediatrics. 

11.  Spencer,  Herbert.     Education,  Intellectual,  Physical  and  Moral, 

p.  156. 

12.  Salisbury.     The  relation  of  Alimentation  to  Disease,  New  York, 

1895. 

13.  Parkes.     Lancet,  1874. 

14.  Caultey,  Edmund.     Sutherland's  System  of  Diet  and  Dietetics. 

15.  Watson.     Food  and  Feeding. 

16.  Hericourt.     Lancet,  1911,  vol.  i,  p.  22. 

17.  RiciiET  and  Hericourt.     Ibid.,  1889. 

18.  Jaffa.    U.  S.  Dept.  of  Agric.  Bull.  No.  107. 

19.  Chambers,  King.     Lectures  Chiefly  Clinical,  Lecture  xxiv. 

20.  Mitchell,  Weir.     Fat  and  Blood,  Philadelphia, 

21.  Dukes,  Clement.     Diet  in  Training  for  School  Gaines. 

22.  Langworthy  and  Beale.      Starr's  Agricultural  Experiment  Sta- 

tion, Ninth  Annual  Report,  1896,  part  ii,  chapter  xi. 

23.  Davis.     Food  in  Health  and  Disease. 

24.  Atwater  and  Bryant.    Dietary  Studies  of  University  Boat  Crews. 

25.     .    TJ.  S.  Dept.  of  Agric.  Bull.  No.  75. 

26.  Thompson,  W.  Gilman.    Practical  Dietetics,  p.  726. 

27-     Atwater  and  Bryant.    TT.  S.  Dept.  of  Agric.  Bull.  No.  75, 


'     REFERENCES  575 

28.  Yeo,  I.  BuRNEY.     Food  in  Health  and  Disease,  p.  281. 

29.  ZuNTz.     IJ.  S.  Dept.  of  Agric.  Exper.  Sta.  Rec,  vol.  vii,  pp.  538- 

550. 
.30.     Stockman  and  Macadam.    Jour.  Phjs.,  1897,  vol.  xxii,  p.  69. 
ol.     Friedenwald  and  Ruiirah.     Diet  in  Health  and  Disease. 
33.     Albu.     Dentsch.  med.  Woehensehr.,  1907. 

33.  Stern.     Med.  Rec,  Dec.  31,  1904. 

34.  Strange.      (On  Kumiss  Cures).     Zeimssen's  Hand  Book  of  Gen- 

eral Therapeutics. 

35.  TiBBLES,  William.     Brit.  Med.  J.,  Sept.  6,  1902. 
3G.     Mitchell,  Weir.     Treatment,  Philadelphia. 

37.     Thompson,  W.  Oilman.     Practical  Dietetics,  pub.  by  D.  Appleton 
&Co. 


CHAPTER   XVII 
PEEPARATION    OF    SPECIAL    BEVERAGES    AND    FOODS 

WITH 

Directions  for  Their  Preparation 


General  Considerations;  Beverages;  Peptonized  and  Predigested  Foods;  Beef 
Teas;  Meat  Juices;  Broths;  Bouillon;  Vegetable  Soups;  Meat  Soups; 
Farinaceous  Foods;  Bread;  Cereal  Foods;  Gruels;  Eggs;  Fish;  Poultry; 
Meats;  Vegetables;  Purees;  Fruits;  Nuts;  Jellies;  Custards;  Puddings; 
Ice  Cream;  Recipes  for  Diabetic  Foods. 


GENERAL    CONSIDERATIONS 

In  the  chapter  on  the  Hygiene  of  Eating,  the  necessity  for  making 
foods  as  palatable  and  as  attractive  as  possible  was  emphasized.  The 
appetizing  preparation  of  food  for  the  sick  is  just  as  important  as  the 
careful  compounding  of  a  prescription  containing  medication.  Convales- 
cent patients,  as  well  as  patients  ill  with  gastric  disturbances,  can  easily 
be  nauseated  by  the  repugnant  appearance  of  a  dish,  while,  on  the  other 
hand,  the  appetite  may  be  stimulated  by  food  of  an  inviting  attractive 
appearance.  The  tray  on  which  it  is  served  should  be  covered  with  pure 
white  linen  without  a  crease  or  wrinkle,  the  best  that  the  home  of  the 
patient  can  aiford.  The  silver  should  be  spotless ;  the  china,  the  daintiest, 
and  the  glassware,  the  clearest;  all  arranged  neatly  and  conveniently. 
This  arrangement  of  the  tray  is  of  the  utmost  importance,  and  the 
slightest  departure  from  regularity  and  immaculate  cleanliness  should 
be  avoided. 

Foods  should  never  be  served  too  hot,  lest  the  patient  be  tempted  to 
partake  of  it  in  that  condition  in  spite  of  the  physician's  or  nurse's  warn- 
ing. On  the  other  hand,  it  should  not  be  served  too  cold.  For  this  reason 
it  is  advisable  to  serve  such  dishes  as  are  liable  to  cool  off  rapidly  in  ves- 

577 


578    PRErARATION  OF  SPECIAL  BEVERAGES  xVisD  FOODS 

sels  of  a  double  bottom,  the  interspace  being  tilled  with  hot  water.  Condi- 
ments have  no  place  in  the  dietary  of  the  invalid  or  convalescent.  Spices, 
however,  may  be  used  with  caution,  but  only  with  permission  of  the 
physician.  A  tray  with  food  should  always  be  carried  into  the  sick-room 
covered  with  a  clean  napkin  or  tray  cover.-  When  the  dietary  ordered  is 
limited  in  variety,  the  patient  is  often  gratified  by  having  his  food  served 
in  courses,  and  will  eat  more  than  if  given  everything  at  once.  A  patient  • 
suffering  with  bowel  disorder  should  never  be  offered  food  until  some  time 
has  elapsed  after  using  the  bed-pan.  Needless  to  state,  the  diet  of  a 
patient  should  be  under  the  supervision  of  the  physician  and  his  direc- 
tions followed  implicitly,  for  much  unnecessary  suffering  and  even  death 
has  followed  the  ingestion  of  forbidden  food. 

BEVERAGES 

PLAIN  BEVERAGES 
lime  Water — Place  a  handful  of  fresh  unslaked  lime  in  an  earthen 
jar  containing  hot  water;  stir,  pour  off,  and  throw  away  the  water  as  soon 
as  it  has  settled.  This  first  water  contains  the  soluble  potash  salts  which 
may  be  present  in  the  lime.  Add  more  water;  allow  it  to  settle,  then  de- 
cant the  clear  fluid  and  bottle  it.  Water  may  again  be  added  to  the  lime, 
and  the  mixture  covered  and  allowed  to  stand  to  be  decanted  as  needed. 

Apple  Water 

Water  (boiling) 1  cupful 250  c.c. 

Apples 2  mashed  baked 150  gm 144  calories 

Pour  the  boiling  water  over  the  apples ;  cool,  strain  and  sweeten.  Serve 
with  shaved  ice  if  desired. 

Tamarind  Water 

Boiling  water 1  cupful 250  c.c. 

Preserved  tamarinds 1  tablespoonful 20  grams 100  calories 

Pour  the  boiling  water  over  the  preserved  tamarinds;  allow  this  to 
stand  until  cool,  then  strain  and  serve  with  shaved  ice. 

Currant  Juice  (Fitch). — 

Cui'rant  juice 1  ounce 30  c.c 25  calories 

or 

Currant  jelly 1  tablespoonful 35  grams 113       " 

Boiling  water 1  cupful 250  c.c. 

Over  the  currant  jelly  pour  the  boiling  water  (use  cold  water  with 
the  juice)  and  sweeten  to  taste. 


BEVERAGES  579 

lemonade  No.  1  (Thompson). — 

Lemon  juice 3  tablespoonfuls 45  c.c. 

Sugar 3  "  30  grams 123  calories 

Cold  water 1  cupful  (6  ounces) 250  c.c. 

To  the  juice  of  the  lemon  add  the  sugar  and  the  cold  water.  Serve 
with  cracked  or  shaved  ice  if  desired. 

Lemonade  No.  2  (Pavy). — 

Rind  of  lemon 1 3  grams. 

Boiling  water 1  pint 480  c.c. 

Sugar 1  ounce 30  grams 114  calories 

Pare  the  rind  from  the  lemon,  cut  the  lemon  into  slices,  and  place  both 
in  a  pitcher  with  the  sugar.  Over  this  pour  the  boiling  water  and  let  it 
stand  until  cool.     Strain  and  serve  with  cracked  ice. 

Effervescent  Lemonade. — This  may  be  made  by  using  a  carbonated 
water  or  by  adding  half  a  teaspoonful  of  bicarbonate  of  soda  or  potash  to 
a  glassful  of  either  of  the  foregoing  lemonades. 

Albuminized  Lemonade  (Watson). — 

Water 1  cupful 250  c.c. 

Lemon  juice 2  teaspoonfuls 30     " 

Sugar 2  "  20  grams 82  calories 

Egg 1  white 32     «         30      " 

Shake  all  the  abo^'e  ingredients  together.     Serve  at  once. 

Orangeade  (Tfuhriih). — 

Rind  of  orange 1 3  grams. 

Boiling  water 1  cupful 250  c.c. 

Juice  of  orange 1 45    "    60  calories 

Sugar 1  tablespoonful 20  grams 82      " 

Cut  the  rind  from  the  orange ;  over  this  pour  the  boiling  water,  then 
add  the  juice  of  the  orange  and  the  sugar;  cool,  strain  and  serve  with 
shaved  ice  if  desired.  If  this  is  too  sweet,  a  teaspoonful  of  lemon  juice 
may  be  added. 

Imperial  Drink  (Gautier). — 

Cream  of  tartar 1  teaspoonful 4  grams. 

Boiling  water 1  pint 480  c.c. 

Juice  of  lemon ^ 15     " 

Add  the  cream  of  tartar  to  the  water.  Into  this  squeeze  the  juice  of 
half  a  lemon,  or  more  if  desired,  sweeten  to  taste  and  serve  cold.  This 
drink  is  most  useful  in  fevers  and  in  nephritis. 


580    PREPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

Barley  Water  (Caultej)(l). — 

Thin:  Put  a  teaspoonful  of  prepared  or  pearl  barley,  previously 
washed  in  cold  water,  into  a  jug;  pour  half  a  pint  of  boiling  water  on  it, 
and  add  a  pinch  of  salt.  Stand  it  by  the  fire  for  an  hour,  stirring  occa- 
sionally, and  then  strain  through  fine  muslin.  Similar  thin  cereal  decoc- 
tions may  be  made  from  rice,  arrowroot  or  oatmeal. 

Thick:  Put  a  heaping  tablespoonful  of  washed,  prepared  or  pearl  bar- 
ley into  a  clean  saucepan,  and  add  a  quart  of  water  and  a  pinch  of  salt. 
Boil  slowly  until  it  has  evaporated  down  to  about  two-thirds  of  a  quart, 
and  strain.  It  may  be  flavored  as  desired.  The  addition  of  a  little  lemon 
peel,  while  boiling,  is  best. 

The  composition  of  barley  water  is  0.09  per  cent  protein,  0.05  per 
cent  fat,  1.6  per  cent  carbohydrate.    It  furnishes  14  calories  to  100  c.c. 

Toast  Water  (Caultey). — Pour  a  pint  of  boiling  water  over  two  or 
three  slices  of  well-toasted  bread.    Let  it  stand  until  cool ;  strain. 

Linseed  Tea  (Yeo). — 

Water 1  pint 480  c.c. 

Linseed 2  tablespoonfuls 60  ?rams 60  calories 

Juice  of  lemon 3^ 15  c.c. 

Bruised    licorice    root    (or    a 

piece  of  licorice  the  size  of  a 

filbert) jounce Sgrams 10      " 

To  the  water  add  the  linseed,  the  juice  of  the  lemon,  the  licorice  root, 
and  rock-candy  to  taste.     Boil  for  one  and  one-half  hours  and  strain. 

Orgeat  (Pavy). — 

Sweet  Almonds 2  ounces 32  grams 200  calories 

Almond  seeds  (bitter) 4 1  gram. 

Orange-flower  water a  little 30  c.c. 

Milk 1  pint 480    « 350      " 

Water 1     " 480   « 

Blanch  the  sweet  almonds  and  bitter  almond  seeds.  Add  the  orange- 
flower  water  and  pound  into  a  paste.  Rub  this  with  the  milk,  diluted 
with  the  water,  imtil  it  forms  an  emulsion.  Strain  and  sweeten  with 
sugar,     (A  demulcent  and  nutritive  drink.) 

NUTRITIOUS    BEVERAGES 

Albumin  Water  (Friedenwald  and  Ruhrah). — 

Egg 1  ounce 50  grams 80  calories 

Water 6  ounces 180  c.c 

Sugar 1  teaspoonful. 10  grams 41       " 

Lemon  juice 1  " 4  c.c 


BEVERAGES  581 

Beat  the  white  of  the  egg  until  very  light  and  strain  through  a  clean 
napkin.  Add  the  water.  If  intended  for  an  infant,  a  pinch  of  salt  may 
be  added.  The  sugar  and  lemon  juice,  or  sherry  wine,  may  be  added  to 
enhance  its  palatableness.  This  drink  may  also  conveniently  be  made  by 
placing  all  the  ingredients  in  a  lemonade  shaker,  shaking  until  thoroughly 
mixed  and  then  straining.     Serve  cold. 

Egg  Albumin  Water  (Watson). — Take  the  white  of  an  egg  (30  calo- 
ries) and  to  it  add  twice  its  own  volume  of  water  and  strain  through 
muslin.  This  gives  about  three  ounces  of  a  clear  solution,  containing  as 
much  protein  as  is  found  in  the  average  sample  of  commercial  beef  juice. 
This  fluid,  added  to  home-made  beef  tea,  makes  a  nutritive  solution  almost 
indistinguishable  from  beef  juice  and  at  a  fraction  of  the  cost. 

Egg  Albumin  Water  (Caultey). — Take  the  white  of  a  fresh  egg  (30 
calories)  and  cut  it  in  numerous  directions  with  scissors.  Shake  it  up  in 
a  flask  \vith  a  pinch  of  salt  and  six  ounces  of  cold  water.  Strain  through 
muslin. 

It  can  be  made  with  thin  barley  water,  and  cream  or  sugar  added. 

Egg  Broth  (Drexel  Institute). — 

Egg 1  (whole) 50  grams 80  calories 

Sugar }4  teaspoonful 5      "     20      " 

Salt a  pinch 1       " 

Hot  milk 1  glass 250  c.c 180      « 

Beat  up  the  egg,  and  add  to  it  the  sugar  and  a  pinch  of  salt ;  over  this 
pour  the  milk  and  serve  immediately.  Hot  water,  broth,  soup,  or  tea  may 
be  used  in  place  of  milk. 

Egg  Cordial 

Egg 1  white 32  grams 30  calories 

Cream 1  tablespoonful 50      "     54      " 

Sugar 1^  "  20      "     82      " 

Brandy 1  "  16  c.c 65      « 

Beat  up  the  white  of  the  egg  until  light ;  add  the  cream  and  beat  up 
together ;  then  add  the  sugar  and  the  brandy. 

Caudle. — 

Egg 1  (whole) 50  grams 80  calories 

Sherry  wine 1  wineglas.sful 30  c.c 38      " 

Sugar 1  teaspoonful 10  grams 41       " 

Gruel  barley }4  pint 120  c.c 130      « 

Beat  up  the  egg  to  a  froth,  add  the  wine,  and  sweeten  with  the  sugar ; 
if  desired,  flavor  with  lemon  peel.  Stir  this  mixture  into  the  gruel,  over 
this  grate  a  little  nutmeg,  and  serve  with  hot  toast. 

137 


582  prepaeatio:n^  of  special  beverages  and  foods 

Cocoa  with  Milk. — 

Cocoa 1  rounding  teaspoonful. .     4  grams 50  calories 

Milk-sugar 2  ounces 60      "     240        " 

Milk 4        "    120  c.c 80 

Cream 2        "    60     " 120        " 

Mix  the  sugar  and  cocoa;  cook  in  the  milk  until  dissolved.  Serve 
with  the  cream. 

Cocoa. — 

Cocoa 1  heaping  teaspoonful. . .     4  grams 50  calories 

Milk-sugar 2  ounces 60  240      " 

Water 3^  cup  (4  ounces) 125  c.c. 

Cream .3  ounces 90     " 180      « 

Mix  the  cocoa  and  sugar,  add  the  water,  and  boil  for  four  or  five 
minutes.    Then  add  the  cream,  or  use  less  and  serve  with  whipped  cream. 

Coffee. — 

Milk-sugar 2  ounces 60  grams 200  calories 

Strong  coffee 4-5     "    120-150  grams. 

Cream 2        «    60  c.c 120      « 

Milk-sugar  may  be  used  likewise  to  sweeten  tea,  which  may  be  served 
with  or  without  cream. 

Ahnond  Milk  (Wegele).— 

Almonds,  sweet 1  pound 453 . 5  grams. . . .  3,030  calories 

bitter 2  pounds 1,000  "     ....6,060       " 

Milk 8  ounces 250    c.c 165      " 

Blanch  the  almonds  that  have  been  soaked  in  cold  water  for  twenty- 
four  hours.  This  is  done  by  pouring  boiling  water  over  them,  when, 
after  a  few.  minutes,  they  can  easily  be  pressed  out  of  their  hulls.  Grind 
the  almonds  in  a  mill  or  pound  them  in  a  mortar;  mix  with  a  half-pint 
of  warm  milk  or  water,  and  allow  the  mixture  to  stand  two  hours,  after 
which  strain  through  a  cloth,  pressing  the  juice  out  well  Thirty  grams 
of  almonds  yield  200  calories  of  heat;  250  grams  of  milk  yield  170 
calories. 

Lemon  Whey. — 

Lemon  juice 3  tablespoonfuls 45  c.c. 

Milk  sugar 2-4  ounces 50-100  grams 200-400  calories 

Kumiss  No.  1  (Drexel  Institute). — 

Skim  milk 1  quart 1,000  c.c 340  calories 

Cake  of  yeast V* 3  grams. 

Sugar 2  tablespoonfuls 80     "     328      « 


BEVEKAGES  583 

Heat  the  milk.  Dissolve  the  jeast  in  a  little  water  and  mix  it  with  the 
sugar  and  lukewarm  milk.  Pour  the  mixture  into  strong  bottles,  stopper 
them  tightly  with  new  corks,  and  tie  down  the  corks  with  stout  twine. 
Shake  the  bottles  well  and  place  in  a  refrigerator.  This  will  allow  the 
mixture  to  ferment  slowly.  After  three  days  lay  the  bottles  on  their  sides, 
turning  them  occasionally.  Five  days  are  required  to  complete  the  fer- 
mentation ;  the  kumiss  is  then  at  its  best. 

Kumiss  No.  2  (Holt). — 

Fresh  milk 1  quart 1,000  cc 650  calories 

Sugar ^  ounce 15  grams 62      " 

Yeast  cake piece 3     " 

Pour  into  wired  bottles  the  fresh  milk,  sugar  and  fresh  yeast  cake 
(half  an  inch  square),  and  keep  at  a  temperature  between  60°  and  70°  F. 
for  one  week,  shaking  five  or  six  times  a  day ;  then  put  upon  ice. 

Further  directions  for  preparing  kumiss  and  kephir  with  kefilac  tablets 
will  be  found  in  the  section  on  Milk,  in  the  chapter  on  Animal  Foods 
(Volume  I,  Chapter  XII,  page  338).  For  the  analytical  value,  see  Vol- 
ume II,  Chapter  XVII,  pages  566-568. 

Milk  Mixture  (A.  V.  Meigs).— 

Cream 2  pints 1,000  cc 1,820  calories 

Milk Ipint 500    « 325      " 

Lime  Water 2  pints 1,000    « 

Sugar  water ' 3      "  1,500    « 512      « 

For  the  sugar  water  use  seventeen  and  three-fourths  drams  of  milk 
sugar  to  a  pint  of  water. 

Milk  and  Cinnamon  Drink  (Ringer).— 

Add  a  small  amount  of  cinnamon  to  the  desired  quantity  of  milk  and 
boil  it.     Sweeten  with  sugar  and  add  brandy  if  desired. 

Albuminized  Milk. — 

Milk 1  cupful 250  cc 170  calories 

Lime  water 1  tablespoonful 15     " 

Egg 1  white 32  grams 30      " 

Shake  in  a  covered  jar  or  lemonade  shaker  the  milk,  lime  water  and 
white  of  the  e^g.     Sweeten,  flavor  as  desired,  and  serve  at  once. 

Irish  Moss  and  Milk. — 

Irish  moss 2  tablespoonfuls ....  28  grams. 

Milk 1  cupful 250  cc 170  calories 


584  PKEPAKATION  OF  SPECIAL  BEVEKAGES  AND  FOODS 

Soak  the  Irish  moss  for  five  minutes  and  wash  thoroughly  in  cold 
water.  Add  the  milk  and  soak  for  half  an  hour;  then  heat  slowly,  stir- 
ring constantly,  and  boil  for  ten  minutes,  preferably  in  a  double  boiler; 
strain,  and  pour  into  cups  to  cool.  This  may  be  sei'ved  while  hot,  and 
may  be  rendered  more  nutritious  by  the  addition  of  the  white  of  an  egg 
stirred  into  it  just  before  serving. 

Egg  and  Buttermilk  Mixture — 

Egg 1  white 32  grams 30  calories 

Cream 2  ounces 80      "     216      " 

Buttermilk 1  glass 250  c.c 78      " 

Beat  the  egg  and  cream  lightly.  Pour  into  a  glass  and  fill  with  fresh 
buttermilk.     Stir  well. 

Milk  and  Other  Diluents — Milk  may  be  diluted  with  advantage  in 
many  cases  by  adding  lime  water,  or  vicliy,  apollinaris,  or  some  other 
sparkling  table  water.  From  one-half  to  one-eighth  the  total  volume  may 
be  added. 

Grape  Juice  (Drexel  Institute)  (2). — Pluck  Concord  grapes  from  the 
stem.  Wash  and  heat  them,  stirring  constantly.  When  the  skins  have 
been  broken,  pour  the  fruit  into  a  jelly  bag  and  press  slightly.  Measure 
the  juice  and  add  one-quarter  the  quantity  of  sugar.  Boil  the  juice  and 
sugar  together  and  then  pour  into  hot  bottles ;  cork  and  seal  with  paraffin 
or  equal  parts  of  shoemaker's  wax  and  resin  melted  together.  Less  sugar 
may  be  used. 

Vanilla,  Bitter  Almond  or  Strawberry  Junket 

Vanilla  or  bitter  almond  extract. 3^  teaspoonful 2  c.c. 

or 
Pure     concentrated     strawberry 

sirup 1  tablespoonful 15    "   88  calories 

Whole  milk H  pint 250    "   170      " 

Add  the  flavoring  extract  to  the  cold  milk  and  then  prepare  in  the 
usual  way.  The  vanilla  or  bitter  almond  extract  or  the  strawberry  siru}) 
should  be  allowed  to  a  half-pint  of  milk. 

Milk  Lemonade  (Kuhrah). — 

Sugar 2  ounces 56  grams 224  calories 

Boiledmilk 5       "  150  c.c 115      " 

Lemon }4      "  65  grams 20       « 

or 

White  Wine 2       "  120  c.c 83       « 

Boiling  water 5       «  150     " 

Rind  of  lemon 14     "  5  grams. 


BEVERAGES  585 

Pour  tlio  boiling  water  over  tlie  peel  and  the  sugar;  allow  it  to  cool, 
add  the  milk,  and  then  the  lemon  juice  or  wine.    Strain  after  ten  minutes. 

Milk  Porridge  (Drexel  Institute). — 

Flour 1  tablespoonful 50  grams 85  calories 

C'okl  milk M  cupful. 63  c.c   45      " 

Hot  milk M       "     63     "   45      « 

Salt yi  teaspoonful 1  gram. 

Mix  the  flour  with  the  cold  milk  and  stir  into  the  hot  milk ;  if  desired 
add  two  raisins  cut  into  quarters.  Cook  over  boiling  water  for  one  hour, 
and  add  the  salt  just  before  serving. 

Plain  Egg  Flip  (Watson).— 

Milk 1  teacup 250  c.c 150  calories 

Sugar 1  teaspoonful 10  grams 41       " 

Egg 1  white 32      «     30      " 

Boil  the  milk  or  make  it  thoroughly  hot ;  beat  up  the  white  of  Q^f^  to 
a  stiff  froth.  Pour  the  boiling  milk  over  the  white  of  Q^;igy  stirring  all  the 
time.    Add  sugar  to  taste,  and  serve. 

BEVERAGES    WITH    EGG    AND    ALCOHOL 

Rich  Egg  Flip  (Watson).— 

Egg 1  white 32  grams 30  calories. 

Cream 1  tablespoonful 20     «       54       " 

Brandy 1  «         15  c.c 58       « 

Sugar  to  taste 1  teaspoonful 10  grams 41       " 

Beat  up  the  white  of  ^^2,  stiffly ;  add  to  it  the  brandy  and  cream,  with 
a  little  sugar  if  wished.    JMix  very  thoroughly  and  serve. 

Egg-nog  (Fitch). — 

Egg 1  (freshly  laid) 50  grams 80  calories 

Powdered  sugar 1  tablespoonful 40     "    160       " 

French  brandy 1  ounce 30  c.c 105      " 

Santa  Cruz  rum 2  drams 75  "   25      " 

Fresh  milk 1  glassful 250  "    170       « 

Cream 1  wineglassful  (2  ounces)  ....  64  "    225      " 

Break  the  ^^"g^  separating  the  white  from  the  yolk,  and  beat  the  yolk 
slowly,  adding  the  sugar  until  it  is  thoroughly  dissolved ;  then  add  the 
brandy,  at  first  drop  by  drop,  vigorously  beating  the  mixture  all  the  time 
until  one-half  is  added,  then  increase  the  flow  until  all  the  brandy  is 
added.  Now  add  the  milk,  pouring  very  slowly,  beating  the  mixture  all 
the  while.     Continue  beating  while  the  rum  is  being  slowly  added.     An 


586    PREPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

assistant  should  have  the  white  of  egg  beaten  to  a  froth,  which  is  now 
dropped  on  top  of  the  mixture.  Add  a  small  pinch  of  gi'ated  nutmeg, 
dusting  over  the  frothy  whites,  and  set  mixture  on  ice  for  an  hour,  when 
it  will  be  ready  to  serve. 

Cold  Egg-nog  (Watson). — 

Egg 1  whole 50  grams 80  calories 

Sugar 2  teaspoonfuls 20  "   80      « 

Milk 1  glassful 250  c.c 170      " 

Brandy  or  good  whiskey 1  tablespoonful 15  "   55      " 

Beat  up  the  egg,  add  the  sugar  and  milk  and  then  the  brandy  or 
whiskey;  mix  thoroughly. 

Hot  Egg-nog 

Egg 1  yolk 18  grams 68  calories 

Sugar 2  teaspoonfuls 20      «     180      " 

Hot  milk 1  glassful 250  c.c 170      « 

Brandy  or  old  whiskey 1  tablespoonful 15  "   55      " 

Beat  the  egg,  add  the  sugar  and  milk,  and  then  the  brandy  or  whiskey ; 
mix  thoroughly. 

Brandy-and-E^  Mixture  (Stokes). — 

Eggs 2  yolks 36  grams 138  calories 

White  sugar }i  ounce 20      "     80      " 

Cinnamon  water 4  ounces 120  c.c. 

Brandy 4        "    120  "   468      " 

Rub  the  yolks  of  the  eggs  with  the  white  sugar,  add  the  cinnamon 
water  and  then  the  brandy.  Dose:  One  or  two  teaspoonfuls  every  two 
hours,  according  to  age. 

Brandy-and-Egg  Mixture  for  Infants  (Louis  Starr). — 

Egg 1  yolk 18  grams 68  calories 

Brandy 3^  ounce 15  c.c 60       " 

Cinnamon  water 1  teaspoonful 4  " 

White  sugar 1  coflfeespoonful 20  «   80      « 

Beat  all  these  ingredients  up  well. 

Egg-nog  (Ruhrah). — 

Egg 1  large 60  grams 80  calories 

Sugar 1  tablespoonful 30      "     120      " 

Whiskey 2  tablespoonfuls 30  c.c 90      " 

Cream 7  "  ....  140  grams 210      " 

Add  the  sugar  to  the  yolk  of  egg  and  beat  until  very  light.  Whip 
the  white  of  the  egg  and  then  the  cream  until  very  stiff.    Add  the  whiskey 


BEVERAGES  587 

to  the  yolk  of  egg  and  sugar.  Mix  well.  Add  one-half  the  cream  to  this, 
then  one-half  the  beaten  white  of  egg,  then  the  remaining  cream,  and 
finally  the  remaining  white  of  egg.  Mix  lightly.  This  recipe  makes  a 
glass  and  a  half. 

Egg-nog  (Bartholow)(3). — Scald  some  new  milk  by  putting  it,  con- 
tained in  a  jug,  into  a  saucepan  of  boiling  water;  it  must  not  be  allowed 
to  boil.  Beat  an  egg  with  a  fork  in  a  tumbler  with  some  sugar ;  add  a  des- 
sertspoonful of  brandy,  and  fill  the  tumbler  with  the  scalded  milk  when 
cold.    This  egg-nog  will  furnish  about  300  calories. 

Beef -tea  Egg-nog  (Davis). — 

"Soluble  Beef" H  teaspoonful 0.5  grams 20  calories 

Hot  water ^  cupful 125  c.c. 

;^-ndy 1  tablespoonful 15      "  60      " 

[      ■ 1  (whole) 50    grams 80      " 

Sugar.. 2  teaspoonfuls 20        "     85      « 

Salt a  pinch 1  " 

Beat  the  egg  slightly,  and  add  the  salt  and  sugar.  Dissolve  the 
"Soluble  Beef"  in  the  hot  water,  add  to  the  egg,  and  strain.  Mix  thor- 
oughly, adding  wine,  and  serve. 

Grape  Juice  and  E^. — 

Egg 1  white 32  grams 30  calories 

Grape  juice 2  tablespoonfuls 30  c.c 20      " 

Beat  the  egg  lightly,  strain  through  a  napkin,  and  add  to  it  the  grape 
juice.  Fill  a  large  wineglass  half  full  of  cracked  ice.  Pour  the  egg  and 
grape  juice  over  this,  sprinkle  sugar  over  it,  and  serve. 

Milk  Punch 

Milk 1  glass 250  c.c 170  calories 

Rum 1  tablespoonful 15  "    45       " 

Sugar 2  teaspoonfuls 20  grams 81       " 

Shake  together  in  a  lemonade-shaker  the  milk,  rum,  brandy  or  good 
old  whiskey,  and  the  sugar.  After  it  has  been  poured  into  a  glass,  a  little 
nutmeg  may  be  grated  over  the  top. 

Egg  Flip. — Boil  or  heat  thoroughly  a  teacupful  of  milk,  beat  the 
white  of  one  egg  to  a  froth.  Pour  the  milk  over  the  egg,  stirring  con- 
stantly.   Add  sugar  to  taste.    This  will  furnish  230  calories. 

Caudle  (Yeo). — Beat  an  egg  to  a  froth;  add  a  glass  of  sherry  and 
half  a  pint  of  gruel.  Flavor  with  a  lemon  peel,  nutmeg  and  sugar.  This 
will  furnish  120  to  150  calories,  according  to  the  consistency  of  the  gruel. 
If  milk  is  used  to  make  the  gruel  it  will  have  a  higher  value. 


588    PEEPAEATION  OF  SPECIAL  BEVEllAGES  AND  EOODS 

Wine  Whey. — 

Milk 1  cupful 250  c.c 170  calories 

Sherry  wine 3^     "         60  "   76      « 

Cook  the  milk  and  sherry  wine  together.  As  soon  as  the  curd  sepa- 
rates, strain  and  sweeten.     This  may  be  eaten  hot  or  cold. 

Mulled  Wine  (Drexel  Institute). — 

Hot  water }4:  cupful 30      c.c. 

Stick  cinnamon H  hich 2      grams. 

Cloves 2  whole 0.5      " 

Nutmeg tiny  bit 05     " 

Port  (heated) 3^  cupful 60      c.c 106  calories 

Sugar 2  tablespoonfuls 28     grams 112      " 

Boil  all  the  ingredients  except  the  wine  and  sugar  for  ten  minutes; 
then  add  the  wine  and  sugar,  strain,  and  serve  very  hot. 

PEPTONIZED    AND    PREDIGESTED    FOODS 

Predigested  protein,  in  the  form  of  peptone  and  albumose,  is  of  value 
principally  in  increasing  the  nutritive  properties  of  liquid  foods.  Its 
principal  value  as  an  aliment  is  in  its  nutritive  property  in  long-continued 
wasting  'diseases.  It  also  has  some  value  as  an  appetizer  when  there  is 
diminished  secretion  of  the  gastric  juice,  and  is  of  use  where  gastric  mo- 
tility and  secretion  are  low,  on  account  of  its  being  a  concentrated  food. 
It  is  useful  in  artificial  feeding  by  the  stomach  tube  or  for  rectal  alimen- 
tations. 

Peptonized  Beef   (Fairchild). — 

Finely  minced  lean  beef }4  pound 100  grams 255  calories 

Cold  water }/^  pint 250  c.c. 

Extract  of  pancreas 20  grains 1 .  25  grams 2      " 

Bicarbonate  of  soda 15      "     1  " 

Egg 1  white 30  "     30      " 

Salt  and  pepper 1  saltspoon 1  " 

Cover  the  lean  beef  (or  beef  and  chicken  mixed)  with  the  cold  water. 
Cook  over  a  slow  fire  until  it  has  boiled  for  a  few  minutes,  stirring  con- 
stantly. Pour  off  the  broth  and  rub  or  pound  the  meat  to  a  paste.  Put 
meat  and  broth  and  half  a  pint  of  cold  water  in  a  glass  jar,  and  add  the 
extract  of  pancreas  and  bicarbonate  of  soda.  Mix  well  and  keep  in  a 
warm  place — at  about  110°-115°  F. — or  place  it  in  warm  water  and 
allow  it  to  stand  three  hours,  stirring  or  shaking  occasionally.  Boil 
quickly ;  strain  or  clarify  with  the  egg,  and  season  with  salt  and  pepper. 


BEVERAGES  589 

If  desired,  it  need  not  be  strained,  as  the  small  particles  of  meat  are 
usually  easily  digested.  Cereals  may  be  added,  boiling  with  half  the 
amount  of  water  previously  directed,  and  mixing  all  together  before  pep- 
tonizing. At  the  end  of  three  hours  the  mixture  must  be  boiled  or  it 
will  spoil. 

Peptonized  Oysters  (Fairchild). — 

Oysters 3^  dozen 85  grams 44  calories 

Water ]/^  pint 250  c.c. 

Extract  of  pancreas 15  grains 1.4  grams 2      " 

Bicarbonate  of  soda 15      "     1  " 

Milk '.H  pint 250  c.c 170      « 

Salt 1  saltspoon 1  gram. 

Pepper 1        "       1 

To  the  oysters  with  their  juice  add  the  water,  and  boil  for  a  few 
minutes.  Pour  off  the  broth  and  set  it  aside.  ^lince  the  oysters,  and 
with  the  aid  of  a  potato-masher  reduce  to  the  consistence  of  a  paste. 
Place  this  with  the  broth  in  a  glass  jar  and  add  the  extract  of  pancreas  and 
the  bicarbonate  of  soda  and  mix.  Allow  this  to  stand  in  hot  water 
(115°  F.)  for  one  and  one-half  hours.  Pour  into  a  saucepan  and  add  the 
milk ;  heat  over  a  slow  fire  to  boiling  point.  Flavor  with  salt  and  pepper 
and  serve  hot.  Let  the  heating  be  done  gradually,  and  be  careful  to  bring 
the  mixture  to  a  boil  before  taking  it  from  the  fire. 

Partially  Digested  Cereals  Prepared  at  the  Table. — To  a  saucer  of  well- 
cooked  oatmeal,  wheaten  grits  or  rice,  at  the  customary  temperature,  add 
one  or  two  teaspoonfuls  of  Fairchild's  Diastasic  Essence  of  Pancreas,  or 
fifteen  grains  of  Fairchild's  Dry  Extract  of  Pancreas.  Stir  for  a  few 
minutes  before  eating.  When  the  ferments  are  added  to  the  very  hot 
foods  their  power  becomes  impaired.  About  100  grams,  energy  value 
about  200  calories. 

Partially  Peptonized  Milk    (Ruhrah). — 

Milk 1  pint 500  c.c 325  calories 

Water 4  ounces 120    " 

Fairchild's  peptonizing  tube 1  1       gram 2      " 

or 

Pancreas  extract 5  grains 0.33    " 

Bicarbonate  of  soda 15      "     1        " 

Into  a  clean  granite-ware  or  porcelain-lined  saucepan  place  the  milk, 
water  and  the  contents  of  tlio  tnl)o,  or  the  pancreas  extract,  and  bicar- 
bonate of  soda.  Heat  gradually  until  it  boils,  stirring  constantly.  Boil 
gently  for  ton  minutes,  strain  into  a  clean  Iwttle,  cork  and  keep  in  a  cool 


590  PEEPAEATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

place.  Before  using,  shake  the  bottle  well ;  serve  hot  or  cold.  Prepared 
in  this  way  it  will  not  become  bitter. 

Peptonized  Milk — 

Cold  Process. — Mix  milk,  water  and  peptonizing  agents  as  directed  in 
the  preceding  recipe,  and  immediately  place  the  bottle  on  ice.  Use  when 
ordinary  milk  is  required.  This  is  particularly  suited  for  dyspeptics  and 
individuals  with  whom  milk  does  not,  as  a  rule,  agree.  The  flavor  of  the 
milk  remains  unchanged. 

Warm  Process. — 

Milk 1  pint 500  c.c 325  calories 

Cold  water 4  ounces 120  " 

Extract  of  pancreas 5  grains 0.33  gm 2      " 

Bicarbonate  of  soda 15      "     1        " 

Put  the  milk  and  cold  water  in  a  glass  jar,  add  the  extract  of  pancreas 
and  the  bicarbonate  of  soda.  After  mixing  thoroughly,  place  the  jar  in 
water  as  hot  as  can  be  borne  by  the  hand  (about  115°  F.).  This  should  be 
heated  for  from  six  to  twenty  minutes.  At  the  end  of  this  time  it  may  be 
placed  upon  ice  until  required.  The  contents  of  one  of  Fairchild's  pep- 
tonizing tubes  may  be  used  in  place  of  the  pancreas  extract.  If  the  milk 
is  to  be  kept  for  any  length  of  time,  it  should  be  brought  to  a  boil,  to  pre- 
vent the  formation  of  too  much  peptone,  which  renders  the  milk  bitter. 

Hot  Peptonized  Milk. — Mix  together  the  usual  peptonizing  ingredients 
and  add  a  pint  of  fresh  cold  milk.  After  thoroughly  shaking  the  bottle 
place  it  on  ice.  When  needed,  pour  out  the  required  amount,  heat  it>  and 
drink  it  as  hot  as  it  can  agreeably  be  taken.  If  required  for  immediate 
use,  the  ingredients  may  be  mixed  together  in  a  saucepan  and  slowly 
heated  to  the  proper  temperature. 

Effervescent  Peptonized  Milk — Put  some  finely  cracked  ice  in  a  glass, 
fill  it  half  full  of  Apollinaris,  vichy  or  siphon  water,  and  immediately  add 
the  peptonized  milk.  Drink  while  effervescing.  Brandy  may  be  added 
if  desired. 

Specially  Peptonized  Milk — This  is  to  be  used  in  the  preparation  of 
jellies,  punches  and  all  recipes  where  the  milk  is  to  be  mixed  with  fruit 
juices  or  acids.  Prepare  according  to  the  hot  process;  keep  the  milk  at  a 
temperature  of  115°  F.  for  one  hour;  pour  into  a  saucepan  and  bring  to  a 
boil.  If  required  hot,  this  may  be  used  immediately,  or  it  may  be  set  aside 
on  ice,  to  be  used  later.  If  not  heated  for  an  hour,  the  milk  will  curdle 
on  being  mixed  with  an  acid.  If  not  boiled,  the  peptonizing  ferment  will 
digest  gelatin  and  prevent  the  formation  of  jelly. 


BEVERAGES  591 

Peptonized  Milk  Jelly    (Friedenwald  and  Euhrah). — 

Cox's  gelatin }/2  box 

Water 4  ounces 120  c.c. 

Hot  specially  peptonized  milk ...  1  pint 500  "   325  calories 

Sugar 4  ounces 112  gm 410  " 

Fresh  lemon 1  whole 130  "   41  « 

Orange 1       «     250  «     96  " 

St.  Croix  rum  or  brandy 3  tablespoonfuls.  . .  50  c.c 245  " 

Soak  the  gelatin  well  in  the  water.  Take  the  peptonized  milk  and  add 
the  sugar.  Put  in  the  gelatin  and  stir  until  it  is  dissolved.  Pare  the 
lemon  and  orange,  and  add  the  rinds  to  the  mixture.  Squeeze  the  lemon 
and  the  orange  juice  into  a  glass,  strain  and  mix  with  the  rum  or  brandy 
if  preferred.  Add  the  juices  to  the  milk,  stirring  constantly.  Strain, 
and  allow  it  to  cool  to  the  consistence  of  sirup.  When  almost  ready  to 
set,  pour  into  cups  and  set  in  a  cold  place.  Do  not  pour  the  milk  into 
moulds  until  the  mixture  is  nearly  ready  to  set,  otherwise  it  will  separate 
in  setting. 

Peptonized  Milk  Lemonade. — 

Cracked  ice J^  glass 80  c.c. 

Juice  of 1  lemon 20  " 

Sugar 3  teaspoonfuls 30  gm 100  calories 

Squeeze  into  the  cracked  ice  the  lemon  juice,  and  add  the  sugar  dis- 
solved in  water.  Fill  the  glass  with  fresh  specially  peptonized  milk  and 
stir  well.  If  preferred,  equal  parts  of  milk  and  of  an  effervescent  mineral 
water  may  be  used.  Pour  the  water  on  the  lenion  juice  and  ice,  and  im- 
mediately fill  the  glass  with  milk. 

Peptonized  Milk  Punch — 

Finely  crushed  ice M  goblet 80  c.c. 

Rum 1  tablespoonful. ...   15  "   50  calories 

Curacao a  dash 5  "   15      " 

Nutmeg a  pinch 

In  the  usual  milk  punch  recipes  the  specially  peptonized  milk  may  be 
used  in  place  of  ordinary  milk.  Take  the  ice,  pour  on  it  the  rum  and 
Curacao,  or  any  other  liquor  agreeable  to  the  taste.  Fill  the  glass  with 
peptonized  milk;  stir  well,  sweeten  to  taste,  and  grate  a  little  nutmeg 
on  top. 

Peptonized  Milk  Gruel. — 

Wheat  flour 1  teaspoonful 

Cold  water J^  pint '. 250  c.c. 

Cold  milk 1  pint 500  «   340  calories 


592    PREPAKATIOX  OF  SPECIAL  BEVERAGES  AND  FOODS 

Mix  the  wheat  flour,  arrowroot  flour  or  Robinson's  barley  flour  with 
the  cold  water.  Boil  for  five  minutes,  stirring  constantly.  Add  the  cold 
milk  and  strain  into  a  jar;  add  the  usual  peptonizing  ingredients;  place 
in  warm  water  (115°  F.)  for  twenty  minutes  and  then  upon  ice. 

Junket,  or  Curds  and  Whey — 

Fresh  milk K  pint 250  c.c 180  calories 

Fairchild's  essence  of  pepsin 1  teaspoonful 

To  the  milk  add  the  essence  of  pepsin  and  stir  just  sufficiently  to  mix. 
Pour  into  custard  cups,  and  let  it  stand  until  firmly  curdled.  It  may  be 
served  plain  or  with  sugar  and  grated  nutmeg.  It  may  be  flavored  with 
wine,  which  should  be  added  before  curdling  takes  place. 

Junket  with  Egg. — 

Egg 1  whole. 50  gm 80  calories 

White  sugar 2  teaspoonfuls 20  "     42      " 

Warm  milk H  pint 250  c.c 180      " 

Essence  of  pepsin 1  teaspoonful 4  " 

Beat  the  egg  to  a  froth,  and  sweeten  with  the  sugar;  add  this  to  the 
warm  milk,  and  then  add  the  essence  of  pepsin  and  let  it  stand  imtil 
curdled. 

Cocoa  Junket  (Fairchild). — 

Cocoa 1  even  tablespoon- 

ful 16  gm 100  calories 

Sugar •. . .  2  teaspoonfuls 20  «    82       « 

Boiling  water 2  tablespoonfuls.  . .  30  c.c. 

Fresh,  cool  milk J^  pint 250  " 180      " 

Fairchild's  essence  of  pepsin 1  teaspoonful 4  " 

Put  the  cocoa  and  sugar  into  a  saucepan ;  scald  with  the  boiling  water 
and  rub  into  a  smooth  paste;  then  stir  in  thoroughly  the  milk;  heat  this 
mixture  until  it  is  lukewarm — not  over  100°  F. ;  add  the  essence  of  pep- 
sin, and  stir  just  enough  to  mix ;  pour  quickly  into  small  cups  or  glasses, 
and  let  it  stand  until  firmly  curdled,  when  the  junket  is  ready  for  use. 
It  may  be  placed  on  ice  and  eaten  cold;  as  a  dessert  it  may  be  served  with 
whipped  cream. 

Coffee  Junket 

Sugar 2  teaspoonfuls 20  gm 82  calories 

Clear,  strong  coffee 2  tablespoonfuls.  . .  30  c.c. 

Fresh,  cool  milk ^  pint 250  "    180      " 

Fairchild's  essence  of  pepsin 1  teaspoonful 4  " 


BEEF    TEAS  593 

Dissolve  the  sugar  in  the  coffee;  mix  this  thoroughly  with  the  milk; 
add  the  essence  of  pepsin  as  directed  above,  and  sei*ve  in  the  same  way. 

Iodized  Junket. — 

Milk Yi  teacupful 120  c.c 85  calories 

Pepsin 2  or  3  teaspoonfuls 

Prescribe  a  saturated  solution  of  potassium  iodid  and  also  a  bottle 
of  essence  of  pepsin.  Take  the  milk  and  add  the  required  number  of 
drops  of  the  iodid  solution.  Heat  the  milk  lukewarm  and  add  the  two 
teaspoonfuls  of  pepsin  and  let  it  stand  until  curdled.  This  will  be  found 
useful  where  it  is  difficult  to  administer  the  iodid  by  ordinary  methods. 

Whey.— 

Fresh  milk 3^  pint 250  c.c 180  calories 

Essence  of  pepsin 1  tablespoonful 

Heat  the  milk  lukewarm  (115°  F.),  add  the  essence  of  pepsin,  and 
stir  just  enough  to  mix.  When  this  is  firmly  coagulated,  beat  up  with  a 
fork  until  the  curd  is  finely  divided  and  then  strain.  For  flavoring  pur- 
poses lemon  juice  or  sherry  wine  may  be  added. 

Grape  Juice  Whey. — 

Orange 1 ,  juice  of 60  c.c 45  calories 

Grape  juice M  pmt 120  "   180       " 

Make  whey  as  in  the  above  recipe.  To  this  add  the  juice  of  the  orange 
and  the  grape  juice.  Strain  again  if  necessary.  This  may  be  served  hot 
or  on  cracked  ice.  It  may  be  sweetened  if  desired.  Energy  about  225 
calories. 

Cream-of -Tartar  Whey  (Pavy). — 

Cream  of  tartar 1  heaping  teaspoonf ul 

Boiling  water 1  pint 

Milk 1  cup 250  c.c 180  calories 

Add  the  cream  of  tartar  to  the  boiling  water.  Strain,  sweeten  to  taste, 
and  serve  cold.    Energy  about  180  calories. 

BEEF    TEAS 

Beef  Tea  (Pavy). — 

Finely  minced  beef 1  pound 454  gm 1,000  calories 

Cold  water 1  pint 500  c.c. 

Salt Yi  teaspoonful 2  gm. 

Put  the  beef  witli  the  cold  water  into  a  suitable  vessel.  Let  it  stand 
for  an  hour,  stirring  occasionally.    Put  the  vessel  containing  the  beef  into 


594    PREPARATIO:^  OF  SPECIAL  BEVERAGES  AND  FOODS 

a  saucepan  of  water,  place  it  over  the  fire,  and  allow  the  water  to  lieat 
gently  for  an  hour  (or  the  vessel  containing  the  beef  tea  may  be  put  into 
an  ordinary  oven  for  an  hour).  Pass  the  beef  tea  through  a  strainer.  A 
fine  sediment  appears  in  the  fluid,  and  this  should  be  drunk  with  the 
liquid.  Flavor  with  salt.  At  no  time  should  the  beef  extract  be  exposed 
to  a  temperature  of  more  than  170°  F. 

Beef  Tea  (Bartholow).— 

Beef 1  pound 454  gm 1,000  calories 

Cold  water 1  pint 500  c.c. 

Chop  the  beef  fine,  free  from  fat,  tendons,  etc.,  and  soak  with  the  cold 
water  for  two  hours.  Let  it  simmer  on  the  stove  for  three  hours  at  a  tem- 
perature never  above  160°  F.  Replace  the  water  lost  by  evaporation  by 
adding  cold  water,  so  that  a  pint  of  beef  tea  shall  represent  a  pound  of 
beef.    Strain  and  carefully  express  all  fluid  from  the  beef. 

Beef  Tea  with  Oatmeal  (Yeo). — 

Groats 1  tablespoonful. ...  30  gm 104  calories 

Cold  water 2  tablespoonfuls.  . .  30  c.c. 

Boiling  beef  tea 1  pint 500  «   150      « 

Mix  thoroughly  the  groats  and  cold  water ;  add  to  this  the  boiling  beef 
tea.  Boil  for  ten  minutes,  stirring  constantly.  Strain  through  a  coarse 
sieve. 

Beef  Tea  (Caultey). — 1.  Mince  one  pound  of  lean  beef,  and  add  to 
it  one  pint  of  cold  water  and  ten  drops  of  dilute  hydrochloric  acid.  Let 
it  stand  for  two  or  three  hours,  with  occasional  stirring,  and  then  simmer 
for  ten  to  twenty  minutes.  Do  not  let  it  boil.  Skim  well.  Energy  value 
25  calories  to  100  c.c. 

2.  Mince  one  pound  of  lean  beef  as  fine  as  possible,  and  pound  it  in  a 
mortar  with  a  small  teaspoonful  of  salt.  Add  the  meat  and  its  juice  to 
one  pint  of  water  at  170°  F.  in  an  earthen  vessel,  and  stand  it  for  an  hour 
by  the  fire,  stirring  at  times.  Then  strain  it  through  muslin,  taking 
care  to  squeeze  all  the  juice  out  of  the  meat.  It  furnishes  25  calories 
to  100  c.c. 

The  composition  of  beef  tea,  !N"os.  1  and  2,  is  92.9  per  cent  water,  4.4 
per  cent  protein,  0.4  per  cent  fat,  1.1  per  cent  carbohydrate. 

Beef  Tea,  Flavored  (Yeo). — Beef  tea  may  be  flavored  agreeably  by 
boiling  in  it  a  pinch  of  mixed  herbs,  a  bay-leaf  or  a  bit  of  onion,  carrot, 
turnip  or  celery  and  a  few  peppercorns.  The  roots  should  either  be 
chopped  small  or  be  scraped  to  a  pulp  before  being  added  to  the  broth. 


MEAT    JUICES  595 

Thick  Beef  Tea,  No.  1  (Watson). — 

Beef  tea  (made) .  .H  pint 250  c.c 75  calories 

Egg 1  yolk 18  gm 68      « 

Tapioca  grout 1  teaspoonful 5  "   15      " 

Warm  the  beef  tea  and  sprinkle  in  the  tapioca,  stirring  all  the  time. 
Let  it  simmer  "slowly  by  the  side  of  the  fire  until  the  tapioca  turns  quite 
clear.  This  will  probably  take  about  fifteen  minutes.  Beat  up  the  yolk 
of  an  egg  in  a  cup,  pour  the  beef  tea  gradually  over  it,  stirring  all  the 
time.     It  is  now  ready  for  serving. 

Beef  Tea,  No.  2  (Watson). — 

Beef  tea  (made) K  pint 250  c.c 75  calories 

Arrowroot 1  teaspoonful 5  gm 15       " 

Cold  water 1  "        4  c.c. 

Mix  the  arrowroot  and  the  water  in  a  small  basin  until  quite  smooth. 
Then  add  it  to  beef  tea  that  is  being  warmed  in  a  pan ;  stir  well  for  a  few 
minutes  to  prevent  it  from  becoming  lumpy.  Then  simmer  slowly  for 
fifteen  minutes. 

MEAT    JUICES 

This  variety  of  food  differs  greatly  in  nutritive  value  from  the  beef 
teas  and  essences  previously  mentioned.  The  meat  juice  is  extracted  with- 
out any  heat  and  under  strong  pressure,  and  thus  a  large  portion  of  the 
albumin  is  present. 

TI ome-made  meat  juice  is  cheaper  than  the  proprietary  preparations, 
and  is  more  valuable  on  account  of  its  freshness,  and  the  absence  of  pre- 
servatives. It  contains  a  relatively  small  quantity  of  extractives,  and  can 
be  given  in,  considerable  amounts  without  causing  diarrhea  or  thirst.  The 
great  drawback  to  the  home-made  product  is  its  red  color,  which  is  de- 
cidedly objectionable.  This  can  be  partially  overcome  by  serving  in  a  red 
glass  or  a  cup. 

Home-made  Meat  Juice  (Watson). — 

Rump  steak  (best) H  pound 115  gm 330  calories 

Cold  water 1  gill 125  c.c. 

Pinch  of  salt  or  sugar  to  taste. 

Wipe  and  shred  the  meat  very  finely,  pound  it  well,  and  rub  it  through 
a  fine  wire  sieve.  Place  in  a  basin  with  water  and  salt,  and  let  stand, 
stirring  occasionally,  for  a  couple  of  hours.  The  liquid  will  then  be  a 
bright  red  color.     Strain  through  a  fine  strainer,  pressing  the  meat  with 


596    PREPARATION  OF  SPECIAL  BEVERAGES  AXD  FOODS 

the  back  of  a  spoon.     The  fluid  obtained  will  contain  4  to  5  per  cent  of 
protein. 

Meat  juice  should  be  made  in  very  small  quantities,  as  it  very  soon  be- 
comes rancid.  Another  method,  such  as  squeezing  the  meat  in  a  lemon 
squeezer,  may  be  tried,  but  this  is  wasteful,  as  the  pressure  is  not  suf- 
ficiently powerful  to  extract  all  the  juice. 

Meat- Juice  Mince  (Watson). — 

Rump  steak  (best) K  pound 230  gm 660  calories 

Butter 1  small  piece 15  «   120       « 

Pepper  and  salt Y^  teaspoonful  each.     2  " 

Rub  the  meat  through  a  hair  sieve  until  all  the  red  juicy  part  has  gone 
through ;  scrape  the  bottom  of  the  sieve.  Melt  a  very  little  piece  of  the 
butter  in  a  small  frying-pan ;  toss  the  meat  juice  in  it  for  three  or  four 
minutes,  until  it  loses  its  red  color.  Flavor  and  serve  with  toast.  This 
looks  just  like  mince,  but  as  none  of  the  fiber  is  present,  it  is  very  digesti- 
ble. This  meat-juice  mince  can  be  made  more  easily  digestible  by  omit- 
ting the  butter,  and  adopting  the  following  method:  Add  to  the  scraped 
meat  a  teaspoonful  of  beef  tea  or  simple  stock,  and  stir  in  an  iron  pan  for 
three  or  four  minutes,  when  the  juice  granulates  and  becomes  brown  in 
color.  If  an  enamel  pan  is  used,  the  meat  has  a  very  unappetizing 
appearance. 

Beef  Juice  (Bartholow). — Broil  quickly  some  pieces  of  round  or  sir- 
loin steak,  of  a  size  to  fit  in  the  cavity  of  a  lemon  squeezer  previously 
heated  by  dipping  in  hot  water.  The  juice  should  be  received  into  a  hot, 
colored  (preferably  red)  wine  glass,  seasoned  to  taste  with  salt  and 
cayenne  pepper,  and  taken  hot. 

Beef  Juice  (Caultey). — Chop  lean  beef  fine,  or  scrape  with  a  fork  or 
meat  scraper  to  separate  the  connective  tissue,  and  put  it  in  a  jar  or  cup 
with  a  pinch  of  salt  and  enough  cold  water  to  cover  it.  Allow  it  to  stand 
from  one  to  six  hours,  and  then  squeeze  well  through  coarse  muslin.  It 
may  be  given  alone  or  mixed  with  other  foods,  warm  or  cold,  but  not  hot. 
It  should  be  warmed  by  heating  the  vessel  in  hot  water. 

Beef  Juice  (Ringer). — Take  one  ounce  of  fresh  beef,  free  from  fat, 
chop  fine  and  pour  over  it  eight  ounces  of  cold  water ;  add  five  or  six  drops 
of  dilute  hydrochloric  acid  and  fifty  to  sixty  grains  of  common  salt,  stir  it 
well,  and  leave  for  three  or  four  hours  in  a  cool  place.  Then  pass  the 
liquid  through  a  hair  sieve,  pressing  the  meat  slightly,  and  adding  grad- 
ually toward  the  end  of  the  straining  about  two  more  ounces  of  water. 
The  liquid  thus  obtained  is  of  a  red  color,  possessing  the  taste  of  soup. 


BROTHS  597 

It  should  be  taken  cold,  a  teaspoonful  at  a  time.  If  preferred  warm,  it 
must  not  be  put  on  the  fire,  but  heated  in  a  covered  vessel  placed  in  hot 
water.    It  furnishes  25  calories  to  100  c.c. 

The  composition  of  beef  juice  is  90.6  per  cent  water,  5  per  cent  pro- 
tein, 0.(>  per  cent  fat. 

Beef  Essence  (Yeo). — 

Lean  beef 1  pound 460  gm 1,320  calories 

Salt a  little 

Chop  the  lean  beef  verv  tine,  free  from  fat  and  skin ;  add  the  salt  and 
put  into  an  earthen  jar  with  a  lid;  fasten  up  the  edges  with  a  thick  paste, 
such  as  is  used  for  roasting  venison  in,  and  place  the  jar  in  the  oven  for 
three  or  four  hours.  Strain  through  a  coarse  sieve,  and  give  the  patient 
two  or  three  tablespoonfuls  at  a  time.    Energy  value  25  calories  to  100  c.c. 

Cold  Beef  Juice. — 

Finely  chopped  lean  beef 1  pound 452  gm 1,000  calories 

Cold  water 8  ounces 250  c.c. 

Cover  the  beef  with  the  cold  water  and  allow  it  to  stand  for  eight  or 
ten  hours.  Squeeze  out  the  juice  by  means  of  a  muslin  bag ;  season  with 
salt  or  sherry  wine,  and  drink  cold  or  slightly  warmed.  It  may  be  added 
to  milk,  care  being  taken  that  the  milk  is  not  too  hot  before  the  juice  is 
added. 

Iced  Meat  Extract  (v.  Ziemssen). — 

Fresh  beef 2  pounds 1  kilo 2,000  calories 

Sugar y^  pound 250  gm 1,000      " 

Freshly  expressed  lemon  juice.  . .  7  ounces 200  "   50      " 

Cognac  containing  vanilla  extract  %  ounce 20  "   5      " 

Eggs 3  yolks 54  "   204      « 

Cut  the  fresh  beef  into  pieces  the  size  of  a  hand;  wrap  in  a  coarse, 
lattice-like  linen  bag,  put  under  a  lever  press,  and  press  slowly.  The 
juice  should  be  caught  in  a  porcelain  dish.  This  is  best  done  by  a  drug- 
gist. By  this  method  about  500  grams  of  juice  are  obtained.  Mix  the 
juice  with  the  sugar  and  lemon  juice  (this  last  is  best  omitted  in  the  case 
of  dyspeptics)  and  the  cognac;  stir  in  well  the  yolks  of  the  eggs,  and  place 
the  entire  mixture  in  a  freezer.    Energy  value  25  calories  to  100  c.c. 

BROTHS 

Broths,  beef  teas,  etc.,  are  home-made  infusions  of  beef,  mutton,  veal 
or  chicken,  and  arc  always  in  demand  for  the  sick-room.     Thev  are  to  be 
138 


598    PKEPARATION  OF  SPECIAL  BEVERAGES  AXD  FOODS 

regarded,  however,  more  in  the  nature  of  pleasant,  palatable  and  stimu- 
lating beverages  than  as  foods.  Their  nutritive  value  depends  entirely  on 
the  method  of  preparation.  If  the  process  of  cooking  is  carried  to  the 
point  that  the  infusion  contains  a  portion  of  the  protein  of  the  meat,  then 
there  is  some  nutritive  value ;  but,  on  the  other  hand,  if  prepared  after  the 
ordinary  routine,  only  the  extractives  and  salts  of  the  meat  are  dissolved 
out  and,  from  the  point  of  view  of  nutrition,  the  value  is  pi'actically 
negative. 

Meat  Broth  (Beef,  Veal,  Mutton  or  Chicken)  (Sutherland). — 

Chopped  lean  meat 1  pound 450  gm 1,000  calories 

Water 1  pint 500  c.c. 

Cover  the  meat  with  the  water  and  allow  it  to  stand  for  from  four  to 
six  hours.  Then  cook  over  a  slow  fire  for  an  hour  until  reduced  to  half 
the  quantity.    Cool,  skim,  pour  into  jar  and  strain. 

Chicken  Broth  (Bartholow). — Skin  aiid  chop  fine  a  small  chicken  or 
half  a  large  fowl,  and  boil  it,  bones  and  all,  with  a  blade  of  mace,  a  sprig 
of  parsley  and  a  crust  of  bread,  in  a  quart  of  water  for  an  hour,  skim- 
ming it  from  time  to  time.  Strain  through  a  coarse  colander.  It  fur- 
nishes 56  calories  to  100  c.c. 

The  composition  of  chicken  broth  is  84  per  cent  water,  10.5  per  cent 
protein,  0.8  per  cent  fat,  2.4  per  cent  carbohydrate. 

Veal  Broth 

Water 1  pint 500  c.c. 

Lean  veal Y2  pound 225  gm 500  calories 

Pour  the  water  on  the  finely  chopped  lean  veal  and  allow  it  to  stand  for 
three  hours.    Boil  for  a  few  minutes,  strain  and  season  with  salt. 

Clam  or  Oyster  Juice  (Drexel  Institute). — Cut  the  clams  or  oysters 
into  pieces  and  heat  for  a  few  minutes  in  their  juice.  Strain  through 
muslin  and  serve  while  hot.  In  straining  great  care  must  be  taken  that 
sand  does  not  pass  through  the  muslin.  The  juice  should  be  diluted  and 
may  be  frozen. 

Clam  Broth  (Drexel  Institute). — 

Clams 3  large 75  gm 40  calories 

Cold  water J^  cupful 125  c.c. 

Wash  the  clams  very  thoroughly,  using  a  brush  for  the  purpose.  Place 
in  a  kettle  with  the  cold  water.  Heat  over  the  fire.  As  soon  as  the  shells 
open,  the  broth  is  done.     Strain  through  muslin,  season  and  serve. 


BROTHS  -  599 

Mutton  Broth  with  Vegetables. — 

Neck  mutton 1  pound 450  gm 1,375  calories 

Water 1  pint 500  c.c. 

Carrots 2  whole 200  gm 36  « 

Turnips 1       «     200  «   54  « 

Onions 3      "     200"   18  « 

Barley 4  tablespoonfuls.  . .  75  "   40  « 

Allow  one  pound  of  neck  mutton  to  each  pint  of  water;  add  the  above 
ingredients.     Let  all  simmer  together  for  three  hours. 

Mutton  Broth  without  Meat — 

"Shankends" 2  bones 1,000  gm 200  calories 

Cold  water 1  pint 500  c.c. 

Cook  the  "shankends"  in  the  cold  water,  add  vegetables  as  directed 
in  the  foregoing  recipe ;  simmer  for  three  hours  and  strain. 

Invalid  Broths  (Thompson)  (4). — To  one  pound  of  chopped  lean  meat 
— chicken,  mutton  or  beef — add  one  pint  of  cold  water ;  let  stand  in  a 
jcovered  glass  fruit  jar  from  four  to  six  hours ;  cook  for  three  hours  in  a 
closed  jar  over  a  slow  fire,  strain,  cool,  skim  oif  the  fat,  clear  with  egg, 
season,  and  use  warm  or  cold. 

These  broths,  except  the  chicken  broth,  possess  essentially  the  same 
fuel  value  as  beef  tea. 

Beef  Broth  with  Poached  Eggs. — Prepare  the  broth  in  the  proportion 
of  half  a  teaspoonful  of  "Soluble  Beef"  to  one  cupful  of  hot  water  and 
add  a  poached  egg. 

A  Nutritive  Drink  for  Delicate  Women  and  Children 

"Soluble  Beef" 14  teaspoonful 2  gm 30  calories 

Boiling  water 5  ounces 150  c.c. 

Cream 3^  ounce 20  gm 72       " 

Mix  the  "Soluble  Beef,"  water  and  cream,  season  with  salt  and  pepper 
to  suit  the  taste. 

Beef  Broth  and  Grain. — 

"Soluble  Beef" 1  teaspoonful 2  gm 30  calories 

Water 1  quart 1,000  c.c. 

Rice 1  tablespoonful. ...      15  gm 20       " 

Take  the  above  ingredients  and  add  salt  to  taste.  Dissolve  the  "Solu- 
ble Beef"  in  the  hot  water,  and  add  the  well-washed  rice.  Simmer 
slowly  until  dissolved  and  absorbed  by  the  rice,  adding  more  beef  broth 
if  too  much  boils  away.  If  not  entirely  dissolved,  the  broth  should  be 
strained  before  using. 


600    PEEPAKATIOX  OF  SPECIAL  BEVEllAGES  AND  FOODS 

BOUILLON 

Plain  Bouillon  (Wegele). — 
Lean  beef K  kg.  (1  lb.) 453  gm 1,086  calories 

Cut  the  beef  into  small  pieces  and  put  same  in  a  vessel  holding  about 
3  pounds  (6  pints)  and  having  a  well-fitting  cover  (or  use  a  double  boiler). 
Fill  vessel  with  cold  water  and  allow  it  to  cook  for  3  to  4  hours.  According 
to  the  strength  required,  it  is  better  to  add  boiling  water  afterward,  mak- 
ing the  bouillon  stronger  or  weaker,  as  desired.  This  makes  about  2 
pounds  (4  pints)  of  bouillon — meat  not  to  be  used  again.  To  obtain  a 
better  taste  and  color,  one  can  brown  the  meat  in,  a  hot  dry  pan  before 
putting  the  meat  into  the  6  pints  of  water. 

Clam  Bouillon  (Pattee). — 

Cold  water %  cupful 187  c.c. 

Clam  broth H      "     125    «... 42  calories 

Scalding  milk }4      «      30    "  45 

Butter 1  tablespoonful. ...   15  gm 120       " 

Salt,  pepper each  3^  teaspoon .  . .     4    " 

Celery  sauce 1  tablespoonful. ...  15    "   48       " 

Whipped  cream 1  «  ....30    "   81 

Blend  the  water  and  clam  broth,  heat  to  the  boiling  point,  then  add 
the  scalding  milk,  the  butter  and  stir  well ;  season  with  salt,  pepper  and 
celery  sauce  to  taste.  A  small  quantity  of  cracker  crumbs  may  be  added 
to  thicken  it.  Serve  in  heated  bouillon  cups  and  garnish  with  the  whipped 
cream. 

Clam  Bouillon  Bisque  (Pattee). — 

Butter }/2  tablespoonful  ...     8  gm 60  calories 

Chopped  onion 1  "  5    "    15 

Chopped  carrot H  "  ....80    "   38 

Clam  broth 1  cupful 250  c.c 84       « 

Flour }/2  tablespoonful. ...  20  gm 15       " 

Boiling  water 1  cupful 250  c.c. 

Egg 1  yolk 18  gm 68 

Cream 3^  cup 40    "    120       « 

Melt  the  butter,  add  the  finely  chopped  onion  and  carrot;  cover  and 
cook  until  the  onion  and  carrot  are  tender,  stirring  occasionally.  Add 
the  flour,  blending  well ;  then  pour  on  gradually  the  boiling  water  and  the 
clam  broth.  Cook  five  minutes,  strain  and  return  to  saucepan.  Mix  the 
yolk  of  egg,  with  the  cream,  and  add  it  slowly  to  the  bisque.  Pour  into 
heated  bouillon  cups  and  serve  with  small  oyster  crackers. 


VEGETABLE    SOUPS  601 

American  Bouillon,  American  Broth  (Yeo). — Place  in  a  tin  vessel  that 
can  be  sealed  hermetically  alternate  laj'ers  of  finely  minced  meat  and 
vegetables.  Seal  it,  and  keep  it  heated  in  a  water  bath  {hain  marie)  for 
six  or  seven  hours,  and  then  express  the  broth. 

Bottle  Bouillon  (Uffelmann). — Cut  beef,  free  from  fat,  into  squares. 
Place  these  in  a  stoppered  bottle,  put  the  bottle  in  a  basin  of  warm  water, 
heat  slowly,  and  boil  for  twenty  minutes.  There  will  be  about  an  ounce 
of  yellowish  or  broAvnish  fluid  for  each  three-quarters  of  a  pound  of  meat 
used.     The  flavor  is  that  of  concentrated  bouillon. 

VEGETABLE  SOUPS 

Soups  without  Meat  (Drexel  Institute). — These  soups  are  thickened 
by  using  butter  and  flour.  This  prevents  a  separation  of  the  thicker  and 
thinner  parts  of  the  soup.  The  butter  should  be  heated  until  it  bubbles, 
the  flour  and  seasoning  added,  and  enough  of  the  hot  liquid  to  make  a 
smooth  sauce  thin  enough  to  pour  easily.  This  should  be  poured  into  the 
rest  of  the  hot  liquid  and  cooked  in  a  double  boiler  until  the  soup  is  of  the 
proper  consistence.  In  soups  made  of  dried  peas  and  beans,  soda  is  used 
to  soften  the  casein.  It  is  also  used  in  tomatoes  to  neutralize  the  acid. 
These  soups  must  be  served  in  hot  dishes  as  soon  as  ready.  Crisp  crackers, 
croutons,  or  soup  sticks  may  be  served  with  them. 

Crisp  Crackers. — Split  and  butter  thick  crackers  and  brown  in  a  hot- 
oven. 

Cream-of-Tomato  Soup. — 

Tomatoes 1  can 450  gm 105  calories 

Soda }4  teaspoonful 1    " 

Butter H  pound 183    "  1,000 

Flour H      "     183    «  500       « 

Salt 3^  teaspoonfuls 12    " 

White  pepper K  teaspoonful 2    " 

Milk 1  quart 1,000  c.c 720 

Stew  the  tomatoes  slowly  one-half  to  one  hour,  strain  and  add  soda 
while  hot;  make  a  white  sauce  and  add  the  tomato  juice.  Serve  im- 
mediately. 

Vegetable  Soup. — 

Spinach 1  handful 200  gm 16  calories 

Beet 1  large 200    "    29 

Carrots 2  small 200    "    18 

Chop  the  vegetables  fine  and  add  to  one  quart  of  water.     Boil  two 


G02    PREPAEATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

hours,  add  water  to  make  quantity  up  to  one  quart  and  strain.    Add  salt 
if  desired.    This  contains  a  large  amount  of  inorganic  salts. 

Cream-of-Celery  Soup  (Ruhrah). — 

Celery 13^  cupf uls 250  gm 45  calories 

Water 1  pint 500  c.c. 

Milk. 1  cupful 250    «   170 

Cream 1       "     250"   440 

Butter 2  tablespoonfuls.  . .  30  gm 240 

Flour K  cupfu' 140    "    400 

Salt K  teaspoonful 2    " 

White  pepper H  "  ....     2    « 

Cook  the  celery  in  the  boiling  water  until  very  soft ;  strain  and  add  the 
hot  liquid ;  make  a  white  sauce  and  cook  until  it  is  thick  cream. 

Cream-of -Potato  Soup  (Wegele). — 

Potatoes,  white 3  whole 300  gm 450  calories 

Milk 2  cupfuls 500  c.c 340 

Cream }^  cupful. . 125    "  220 

Eggs 2  yolks 54  gm ^204 

Salt 1  teaspoonful 4    " 

Pepper 3^  «  1    " 

Onion  juice ^  "          2    « 

Cook  the  potatoes  until  soft,  drain,  mash,  add  the  hot  liquid  and  strain ; 
add  the  beaten  yolks  and  seasoning.  Cook  in  a  double  boiler  until  the 
egg  thickens,  stirring  constantly.    Serve  immediately. 

Tapioca  Soup   (Yeo). — 

Meat  broth  or  stock 1  pint 600  gm 454  calories 

Previously  washed  tapioca ^  ounce 21    "    21       " 

Boil  the  broth  or  stock,  and,  while  stirring  constantly,  sprinkle  in  the 
tapioca.  Cover  the  saucepan,  and  let  it  stand  until  the  tapioca  is  quite 
soft.     Skim  and  serve. 

Julienne  Soup  (Vegetarian)    (Watson). — 

Vegetable  stock  (clarified) 1  quart 1,000  c.c 360  calories 

Mushroom  ketchup 2  tablespoonfuls.  . .      30    " 

Salt  and  pepper }/^  teaspoonful 2  gm. 

Turnip,  carrot,  celery,  onion ....  4  ounces,  each 400    "  160       " 

Walnut  ketchup 2  tablespoonfuls.  . .      30  c.c. 

Sherry 3^  cup 120    « 160 

Cut  the  vegetables  into  fine  strips  about  the  size  and  shape  of  a  small 
match,  and  boil  them  separately  until  tender  but  not  broken.     Have  the 


VEGETABLE    SOUPS  603 

stock  ready  boiling;  add  salt,  pepper,  a  very  little  ketchup  and  sherry  to 
taste;  put  in  the  prepared  vegetables,  cook  for  fifteen  minutes  and  serve. 

White  Soup  (Watson). — 

Onions 2  small 200  gm 84  calories 

Celery 1  head 200    "  32 

Milk H  pint 250  c.c 170 

Turnip 1  whole 560  gm 24 

Artichokes 2  French 720    "  194 

Flour 1  dessertspoonful . .      15    "  15       " 

Potatoes  (white) 1  pound 550    «  385       " 

Water 3  pints 1,500  c,c. 

Butter 1  ounce 30  gm 240       " 

Cut  about  2  pounds  weight  of  any  white  vegetables,  wash  and  peel  and 
cut  in  pieces  and  boil  until  soft  in  the  water ;  salt  and  butter.  Rub  them 
through  a  sieve  or  colander,  put  them  back  in  the  stewpan  with  the  milk, 
and  let  it  boil.  Put  in  the  flour,  mixed  smoothly  with  cold  water,  let  the 
soup  boil  for  ten  minutes  and  serve  with  slices  of  fried  bread. 

Clear  Soup  or  Consomme   (Watson)  (5). — 

Soup  stock 1  quart 1,000  c.c 360  calories 

Lean,  juicy  beef >^  pound 260  gm 700       " 

Sugar 1  lump 10    "  41       " 

Egg 1  whole.  .........      50    «  80       " 

The  stock  should  be  in  the  form  of  a  good  jelly. 

Method:  Carefully  remove  all  fat  from  the  top  of  the  stock,  and  put 
it  into  a  clean  lined  saucepan.  Wipe  the  beef  with  a  damp  cloth,  and 
shred  it  finely  as  you  would  for  beef  tea.  removing  all  fat  and  skin.  Add 
this  to  the  stock,  with  the  white  of  the  Qgg  and  the  shell,  well  washed  and 
crushed.  Wliisk  these  over  the  fire  with  a  wire  whisk  until  the  soup  just 
comes  to  the  boiling  point.  Then  remove  the  whisk,  and  let  the  soup  boil 
up.  Draw  the  pan  to  the  side  of  the  fire,  where  the  soup  will  keep  warm 
but  not  simmer,  and  cover  it  with  a  plate.  Let  it  stand  there  from  ten  to 
fifteen  minutes.  Tie  a  clean  cloth  on  to  the  four  legs  of  a  chair  turned 
upside  down,  letting  it  fall  slightly  in  the  middle  so  as  to  form  a  bag. 
Pour  some  boiling  water  through  the  cloth  into  a  basin  to  heat  the  cloth 
thoroughly.  Then  strain  the  soup.  Tt  will  not  be  clear  the  first  time,  so 
change  the  basin  and  pour  the  soup  through  again,  repeating  this  process 
until  it  is  quite  clear.  Tn  repeating,  add  a  lump  of  sugar,  which  makes 
the  soup  sparkle. 

This  soup  can  be  varied  by  the  addition  of  different  garnishes,  e.g.. 


604    PEEPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

Consomme  and  Egg  (Watson). — 

Consomm^ 1  quart 1,000  gm 110  calories 

Egg 1  (whole) 50    "  86 

Put  the  clear  soup  into  a  saucepan,  and  bring  it  to  the  boil.  Beat  up 
the  egg  in  a  small  cup  or  basin  with  a  fork,  and  pour  it  slowly  into  the 
boiling  soup,  stirring  all  the  time  with  a  spoon.  The  egg  will  curdle  in 
the  soup,  and  look  like  threads  of  yellow. 

Lentil  Soup  (Watson). — Wash  the  lentils  thoroughly  in  cold  water, 
and  add  them  to  water  in  the  proportion  of  %  pound  lentils  to  a  gallon  of 
water  or  of  second  stock.  Add  pepper,  salt,  onion,  turnips,  carrot  and 
celery.  Boil  all  for  three  or  four  hours.  Pass  through  fine  wire  sieve  or 
colander,  put  on  a  few  minutes  to  heat,  and  send  to  table  with  toast  cut  in 
dice.  A  little  curry  powder  may  be  added  if  desired.  This  soup  is  some- 
what apt  to  cause  flatulence  in  those  of  weak  digestion,  but  if  made  with 
Benger's  pancreatized  lentil  flour  and  without  the  additional  vegetables, 
it  will  be  found  very  acceptable  to  the  most  delicate  stomach.  Pea  soup 
served  with  dried  mint,  and  haricot  bean  soup  can  be  made  in  the  same 
way.    Fuel  value,  100  grams,  130  calories. 

Brunoise  Soup  (Watson). — 

Carrot,  young 1  (whole) 

Turnip,  young J^ 

Celery 2  leaves 

Flower  of  small  cauliflower 1  small 

Onion 1  (whole) 

Butter 1  ounce 

Milk 1  pint 

Water 1     «    

Salt 1  teaspoonful . 

Pepper }4  " 

Stale  bread,  toasted 2  ounces 


.100  gm 

18  calories 

140    "  

6 

« 

20    «   

3 

u 

10    «  

1 

u 

100    «   

42 

u 

30    «   

240 

u 

500  CO 

350 

u 

500    « 

4  gm. 

1    " 

60    "   

200 

tt 

Stew  the  ingredients  together,  except  the  toast,  for  one  hour,  then 
break  the  toast  in  pieces,  add  it  to  the  rest,  and  stew  all  together  for 
another  hour.    Pass  all  through  a  sieve  and  return  to  the  stewpan  to  heat. 

Potato  Soup  (Watson). — 

Potatoes 1  pound 550  gm 385  calories 

Leek 1  (medium) 100    "    40 

Onion 1  «        100    «    42 

Butter 1  ounce 30    "    240 

Milk 1  pint 500  c.c 340 

Water , , 1     "   500    " 


2,000  c.c. 

30  gm 

240  calories 

37  «  

99   " 

200  "  

84   « 

550  " 

145   « 

300  "  

304   " 

200  «  

36   « 

280  "   

12   « 

MEAT    SOUPS  605 

Stew  the  potatoes,  put  them  with  leek,  onion  and  butter  into  a  pint 
of  boiling  water  in  a  stewpan.  Boil  until  the  vegetables  are  soft,  then 
pass  them  through  a  sieve,  adding  a  pint  of  hot  milk.  Put  the  mixture 
into  the  stewpan  until  it  boils.     Serve  vidth  dice  of  fried  bread. 

Brown  Vegetable  Soup  (Watson). — 

Water 2  quarts 

Butter 1  ounce 

Bread 1  slice 

Onions 2  (whole) 

Cabbage 1  pound 

Potatoes 2  (whole) 

Carrots 2       «      

Turnip 1  (large) 

Parsley,  salt  and  pepper. 

Fry  a  slice  of  onion  in  a  large  saucepan.  When  it  is  brown,  but  not 
burned,  add  water,  salt  and  pepper,  bread  toasted  and  vegetables  cut  into 
small  pieces.  Boil  three  or  four  hours,  then  rub  the  vegetables  through 
a  colander  and  boil  again  for  ten  minutes,  when  the  soup  is  ready.  If 
too  thick,  add  a  little  more  water. 

MEAT    SOUPS 

All  soups,  bouillons  and  broths  consist  principally  of  salts  and  ex- 
tractive substances.  They  merely  serve  as  appetizers  by  exciting  the  gas- 
tric secretions,  and  have  very  little  nourishing  or  caloric  value.  In  atony 
of  the  stomach,  hypersecretion  and  general  hyperesthesia,  bouillon  is 
contra-indicated,  as  it  increases  gastric  secretion.  During  hot  weather, 
on  account  of  its  tendency  to  fermentation,  bouillon  should  always  be 
freshly  prepared.  Beef  tea  is  much  more  nutritious  than  ordinary 
bouillon,  and  freshly  made  beef  juice  is  much  more  nourishing  than  any 
of  the  other  preparations. 

General  Directions  for  Soupmaking — In  order  to  expose  as  large  a  sur- 
face to  the  water  as  possible,  the  meat  is  cut  up  into  pieces,  while  the 
solvent  power  of  the  water  is  increased  by  the  addition  of  a  little  vinegar. 
The  temperature  is  kept  at  a  little  below  160°  F.  for  several  hoiirs.  As 
vegetables  require  a  very  much  greater  heat  than  this  to  soften  them, 
they  should  either  be  first  boiled,  and  then  the  meat  should  be  added,  or 
the  vegetables  can  be  cooked  separately,  and  only  added  to  the  soup  when 
it  is  almost  ready.  This  preser\'es  the  color  best.  Flavoring  herbs  should 
bo  put  in  at  the  last  moment.  In  all  soups  made  from  meat,  great  care 
should  be  exercised  in  the  removal  of  the  fat.    This  is  done  by  making  the 


140  "  

6 

4  " 

200  "  

84 

55  "  

101 

4  «  

8 

2  "  

2 

12  "  

2 

12  " 

... ..  2 

100  "  

4 

606    PREPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

soup  the  day  before  it  is  required,  putting  aside  in  a  basin  to  cool,  and 
when  it  is  quite  cold  carefully  skimming  the  fat  from  the  top. 

First  Stock  for  Clear  Brown  Soup  (Watson), — 

Shin  of  beef 1  pound 550  gm 600  calories 

Knuckle  of  veal 1      «     550    "  615 

Cold  water 3  quarts 3,000  c.c. 

Carrot 1  (whole) 100  gm 18 

Turnip 1        "       

Mixed  herbs 1  teaspoonf ul .  .  . 

Small  onions 2  (whole) 

Celery,  or 2  or  3  stalks .... 

Celery  seed 1  teaspoonf  ul .  .  . 

Peppercorns 2  dozen 

Cloves 8  seeds 

Mace 1  blade 

Parsley A  few  stalks .... 

Salt 1  dessertspoonful . .        8    " 

Wipe  the  meat  with  a  damp  cloth,  and  remove  all  marrow  from  the 
bone.  Take  a  very  sharp  knife  and  cut  the  meat  into  small  pieces,  keeping 
back  any  fat,  but  using  the  skin.  Put  the  bones  and  meat  into  a  stock  pot 
with  the  cold  water  and  salt,  and  let  them  soak  for  half  an  hour,  then  put 
the  pot  on  the  fire,  and  bring  the  contents  slowly  to  the  boil.  Simmer  for 
half  an  hour,  and  then  remove  any  scum  that  may  be  on  the  top.  Add 
the  vegetables,  prepared  and  cut  rather  small,  and  the  herbs,  celery  seed, 
and  peppercorns,  etc.,  tied  in  a  small  piece  of  muslin.  Simmer  slowly 
from  four  and  a  half  to  five  hours,  never  letting  it  go  off  the  boil.  Then 
strain  through  a  hair  sieve  or  cloth  stretched  over  a  colander,  and  let  stand 
until  cold.  A  darker -colored  stock  may  be  obtained  by  frying  the  meat 
in  a  little  dripping  or  butter  before  pouring  on  the  water. 

Do  not  throw  away  the  meat  or  vegetables  left  after  straining,  but  put 
them  on  again  with  the  same  quantity  of  water  as  before,  and  boil  again 
for  second  stock. 

Fish  Soup  (Watson). —    . 

Small  haddock  or  whiting,  or  piece 

of  cod 4  ounces 100  gm 108  calories 

Butter 3^  ounce 15    «  120 

Flour y^      "    15    "  15 

Cold  water 1  pint 500  c.c. 

Milk 1  gill 166   « 120 

Egg 1  yolk 18  gm , .  68       « 

Cream 3^  gill 80  c.c. 139       « 

Finely  chopped  parsley 1  teaspoonful 4  gm. ..,.., 2       ** 


MEAT    SOUPS  607 

Wash  and  scrape  the  fish  very  clean.  See  that  there  is  no  black  skin 
lining  the  inside  parts.  Remove  the  eyes.  Cut  the  fish  across  into  several 
pieces,  and  put  them  in  a  lined  saucepan,  cover  with  cold  water  and  add 
the  salt.  Bring  to  the  boil  and  skim.  After  the  fish  has  boiled  for  a  few 
minutes,  pick  out  a  few  of  the  best  pieces  of  fish,  free  them  from  skin  and 
bone,  and  reserve  them  for  serving  in  the  soup.  Allow  the  rest  to  simmer 
from  three-quarters  to  one  hour.  Then  strain  through  a  wire  sieve,  and 
rub  some  of  the  white  pieces  through.  Rinse  out  the  pan  the  soup  was 
cooked  in.  Melt  in  it  the  butter,  add  the  flour,  and  mix  these  two 
smoothlv  together,  being  careful  they  do  not  brown.  Then  pour  on  the 
soup  and  stir  until  boiling.  Beat  the  yolk  of  egg  and  cream  and  milk 
together,  and,  when  the  soup  is  off  the  boil,  beat  these  ingredients  into  it. 
Strain  through  a  fine  strainer,  stirring  all  the  time.  Do  not  let  the  soup 
boil  after  the  egg  is  added,  or  it  will  curdle.  The  pieces  of  fijsh  that  were 
reserved  and  the  chopped  parsley  are  now  added. 

Egg  Dumpling  Soup  (Wegele). — 

Eggs 2  (whole) .100  gm 160  calories 

Flour (bounce) 7    «  6 

Thoroughly  mix  the  yolk  of  the  eggs  with  the  flour.  Beat  stiff  the 
whites  of  two  eggs  and  add  to  above.  Drop  the  dumplings  into  the  soup 
with  a  teaspoon,  and  allow  the  soup  to  boil  up  once  or  twice.  Take  out 
the  dumplings  carefully  with  a  skimmer,  so  they  will  not  break,  put  into 
the  soup  plate  and  then  add  the  soup. 

Oyster  Stew  (Fitch).— 

Milk 1  cupful 250  c.c 170  calories 

Oysters 1  pound 453  gm 230       « 

Salt }i  teaspoonful 1    " 

Butter 1  tablespoonful. ...   15    "  -. 120       " 

Pepper ^  saltspoon 

Heat  the  milk.  Cook  and  strain  the  oyster  juice.  Add  the  oysters, 
which  have  been  rinsed,  and  cook  until  the  edges  curl.  Add  seasoning, 
butter  ar.d  hot  milk.  Serve  at  once.  This  soup  may  be  thickened  with  a 
tablespoonful  of  flour  cooked  in  the  butter. 

Sweetbread  Soup  (Wegele)  (6). — The  sweetbread  is  soaked  in  cold 
.  water  for  one  hour,  the  water  being  renewed  frequently  during  this  time. 
It  is  then  boiled  for  one  hour  in  slightly  salted  water  or  beef  broth,  to 
which  may  be  added  one  teaspoonful  of  julienne  to  improve  the  taste. 
After  it  is  soft,  the  sweetbread  is  taken  out  of  the  broth  and  all  blood 
vessels  and  skin  are  removed.    It  may  then  be  cut  into  pieces  the  size  of 


608    PEEPAEATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

a  walnut  and  put  on  a  plate,  over  which  the  broth  is  poured,  or  the  sweet- 
bread may  be  forced  through  a  sieve,  the  beef  broth  poured  over  this,  and 
the  whole  put  on  the  fire  again  until  it  boils,  after  which  the  soup  may  be 
served.  This  latter  process  is  to  be  recommended  in  the  case  of  dyspep- 
tics. One  hundred  drams  of  raw  sweetbread  generate  about  90  calories 
of  heat.  1 

Oyster  Soup  (Watson). — 

Oysters 1  dozen 170  gm 88  calories 

Fish  stock  or  white  stock 1  pint 250  c.c 100       " 

Butter 1  ounce 30  gm 240       " 

Flour 1      "     30    «  30 

Cayenne a  pinch 0.2    " 

Cream 4  tablespoonfuls 160  c.c 278       « 

Egg 1  whole 50  gm 80       " 

Anchovy  essence a  few  drops 

Lemon  juice a  squeeze 

White  pepper  and  salt 

Place  the  oysters  in  a  small  saucepan  with  their  own  liquor,  bring 
them  almost  to  the  boil,  then  strain.  Beard  the  oysters  (that  is,  remove 
the  piece  like  a  fringe  that  encircles  them),  cut  them  in  two,  and  put  them 
aside  for  stewing  in  the  soup.  Put  the  beards  into  a  saucepan  with  the 
liquor  and  the  stock,  and  let  them  simmer  for  half  an  hour  to  extract  all 
the  flavor  from  them.  If  the  stock  is  not  previously  well  flavored,  small 
pieces  of  the  different  flavoring  vegetables  ^  should  also  be  cooked  in 
it.  Strain  through  a  fine  hair  sieve  or  piece  of  muslin,  and  rinse  out 
the  saucepan  ready  for  use.  First  melt  in  it  the  butter,  being  careful 
it  does  not  brown,  add  to  it  the  flour  and  mix  together  until  quite  smooth. 
Pour  on  the  stock,  and  stir  constantly  over  the  fire  until  boiling.  Skim 
if  necessary.  Season  to  taste  with  a  little  white  pepper,  salt,  anchovy 
essence,  and  pinch  of  cayenne.  Beat  up  the  yolk  of  eggs  in  a  basin  with 
the  cream  and  strain  into  the  soup.  When  off  the  boil,  stir  all  the  time. 
Place  oysters  in  the  soup  tureen,  pour  the  soup  over  them  and  serve. 

FARINACEOUS   FOODS 

Boiled  Rice  (U.  S.  Army  Hospital  Recipe). — 

Rice 1  ounce 30  gm. 

Salt 20  gm. 

Water 4  ounces 

Put  the  salt  and  water  into  a  stewpan.  When  boiling  add  the  rice, 
previously  washed  thoroughly.     Boil  for  ten  minutes,  or  until  each  grain 

1  Volume  I,  Chapter  XVII,  page  040. 


FARINACEOUIS    FOODS  609 

becomes  soft.  Drain  it  on  a  colander.  Grease  the  stewpan  with  chirified 
dripping-s  or  lard.  Put  back  the  rice.  Let  it  swell  slowly  near  the  tire, 
or  in  a  slow  oven,  for  about  twenty  minutes,  until  the  grains  are  well 
separated. 

Boiled  rice  furnishes  GO  calories  to  1  tablespoonful. 

Cornmeal  Mush  {Individual  Rule)   (Pattee). — 

Cornmeal 1  ounce 30  gm 100  calories 

Flour }4  tablespoonful. ...   15    «  40       " 

Salt 3^  teaspoonful 1     " 

Cold  milk K  cupful 30  c.c 40 

Boiling  water H      "     125   " 

Mix  the  meal,  flour  and  salt  with  the  cold  milk  or  water ;  when  smooth, 
stir  into  the  boiling  water.  Cook  in  a  double  boiler  one  hour  or  more,  or 
over  direct  heat  one-half  hour.  Serve  with  cream  and  sugar.  If  wanted 
for  sauteing  turn  into  tins  to  cool.  Cut  into  slices,  dip  in  flour  and 
saute  in  drippings  or  butter. 

Hominy  Mush  (Pattee). — 

Fine  hominy J4  cupful 30  gm 100  calories 

Salt 3^  teaspoonful 1    " 

Boiling  water 1 J^  cups 333  c.c. 

Put  all  the  ingi'edients  together  in  a  double  boiler  and  cook  two  hours. 
Add  more  water  if  mush  seems  stiff  and  thick.  All  preparations  of  corn 
absorb  a  great  deal  of  water  in  cooking,  and  hominy  usually  needs  a  little 
more  than  four  times  its  bulk. 

Note. — Hominy  is  exceedingly  indigestible  unless  well  cooked,  but 
sweet  aud  nutritious  when  subjected  to  a  high  temperature  for  a  long  time. 

Oatmeal  Mush  for  Children  and  Invalids  (Pattee). — 

Granulated  oatmeal 1  cupful 453  gm 380  calories 

Salt 1  teaspoonful 1     " 

lioiling  water 1  scant  quart 1,000  c.c. 

Put  the  oatmeal  and  salt  in  a  double  boiler,  pour  on  the  boiling  water, 
and  cook  three  or  four  hours.  Remove  the  cover  just  before  ser\'ing,  and 
stir  with  a  fork  to  let  the  steam  escape.  If  the  water  in  the  lower  boiler 
be  strongly  salted,  the  oatmeal  will  cook  more  quickly.  Serve  with  sugar 
or  salt  and  cream  or  milk. 

Note. — Baked  sour  apples,  apple  sauce  and  apple  jelly  are  delicious 
eaten  with  oatmeal.  They  should  be  served  with  the  mush,  and  sugar  and 
cream  poured  over  the  whole.     They  give  the  acid  flavor  which  so  many 


y 


610    PREPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

crave  in  the  morning.  Coarse  oatmeal  is  not  advisable  in  any  form  of 
water  brash,  acidity  or  bowel  irritations.  It  often  causes  eruptions  on 
the  skin  in  warm  weather. 

Rice  and  Macaroni  (Watson). — These  carbohydrates  are  the  basis  of 
many  nourishing  and  easily  digested  Italian  dishes.  In  cooking,  the 
directions  for  boiling  rice  and  macaroni  should  be  closely  followed. 

Plain  Boiled  Rice  (Watson). — Wash  well  some  Patna  rice  in  several 
waters  until  the  last  water  looks  quite  clean.  If  there  is  a  pot  for  steam- 
ing the  rice  in  it  is  best  to  use  this,  but  if  not,  boil  the  rice  in  a  saucepan 
of  boiling  water  containing  salt,  which  is  in  the  proportion  of  one  tea- 
spoonful  to  the  quart.  Boil  quickly  with  the  lid  off,  stirring  it  frequently 
with  a  fork  to  prevent  it  sticking  to  the  pan.  Cook  from  ten  to  fifteen 
minutes  until  the  grain  will  rub  down  easily  when  tested  between  the 
finger  and  thumb.  Strain  through  a  sieve  or  strainer,  and  dry  the  rice 
either  by  putting  it  into  the  saucepan  by  the  side  of  the  fire,  or  putting  it 
on  a  plate  in  a  moderate  oven.  While  drying,  stir  lightly  with  a  fork 
every  now  and  then  to  keep  the  grains  separate.  The  water  in  which  the 
rice  has  been  boiled  contains  the  best  part  of  the  rice,  so  it  should  not  be 
thrown  away,  but  kept  for  the  stock  pot. 

Italian  Rice  (Cheese  and  Rice)  (Watson). — Boil  the  rice  as  directed 
above,  strain  and  pour  back  into  a  pan.  Put  a  sufficient  quantity  of  butter 
into  a  frying  pan ;  when  the  butter  is  melted  add  the  rice,  and  mix  well 
together  for  two  or  three  minutes.  Place  the  rice  in  a  dish  and  cover  with 
grated  Parmesan  cheese. 

Boiled  Macaroni  (Watson). — ^Break  the  macaroni  into  short  lengths, 
and  throw  it  into  a  saucepan  of  freshly  boiling  water  with  salt  in  it.  Boil 
quickly,  with  the  lid  off,  until  it  has  thoroughly  swelled  and  is  tender. 
Stir  occasionally,  to  prevent  it  sticking.  The  time  depends  on  the  variety 
of  the  macaroni — the  large  pipe  will  take  about  half  an  hour,  the  small 
much  longer.  Keep  it  well  covered  with  water.  When  done,  drain. 
Boiled  macaroni  may  either  be  served  plain  with  meat,  or  it  may  be  put 
back  into  the  saucepan  with  enough  stock  to  cover  it  and  allowed  to  stew 
for  half  an  hour.  The  pulp  of  a  fresh  tomato  rubbed  through  a  sieve  may 
also  be  added. 

Farina  Dumplings  (1)  (Wegele). — 

Farina 2  ounces 60  gm 200  calories 

Boiling  milk %  pound  (Ij^  pints).750  c.c 510       « 

Egg 1  (whole) 50  gm 80 

Butter Yz  ounce 15    "  120       « 


FARINACEOUS    FOODS  611 

Pour  the  farina  slowly  into  the  boiling  milk  to  avoid  its  getting  lumpy. 
When  thick,  take  off  the  fire,  add  the  egg,  and  put  back  on  the  fire,  but  do 
not  let  the  farina  get  too  hot.  Dip  a  fiat  spoon  into  the  melted  butter,  and 
with  this  drop  the  farina  into  the  hot  milk  a  spoonful  at  a  time.  Place 
the  dumplings  on  a  dish  and  serve  at  once. 

Farina  Dumplings  (2) . — 

Butter 1^  ounces 50  gm 384  calories 

Boiling  milk 2}4  pints 1,250  c.c 850 

Salt a  little 1  gm. 

Farina H  pound 260    «  800       « 

Eggs 5  (whole) 250    "  400       « 

Put  the  butter  into  the  boiling  milk,  add  a  little  salt  and  the  farina. 
Boil  until  stiff.  Let  the  mixture  cool  off  and  add  the  eggs.  Drop  the 
dumplings  into  boiling  water  with  a  spoon,  and  let  them  boil  for  about 
one-quarter  hour.    This  portion  is  large  enough  for  four  persons. 

Farina  Dumplings  (3). — 

Farina ^  pound 260  gm 800  calories 

Milk 1  pound  (2  pints). 1,000  c.c .680       « 

Eggs 6  (whole) 300  gm 480       " 

Salt a  little 1    « 

BreadorroUs 2  sUces 75    «  200       « 

Hot  butter 

Boil  the  farina  in  the  milk  until  soft.  Let  it  cool  off,  and  add  the 
eggs  and  the  salt.  Cut  the  bread  or  rolls  into  small  squares,  roast  in  hot 
butter,  add  to  the  farina  and  mix  well.  Put  everything  into  a  pudding 
dish  and  let  it  steam  for  one  hour. 

Potato  Dumphngs  (Pattee). — 

Grated  potatoes 20  tablespoonfuls .  1,000  gm 1,120  calories 

Butter 13^  ounces 50    «    384 

Eggs 3  (whole) 150    «    240       « 

Salt a  little 1    « 

Farina IH  ounces 50    "    180 

Boil  the  grated  potatoes  the  day  before  using  and  mash  thoroughly. 
Add  the  butter,  mixing  thoroughly ;  also  the  yolks  of  the  eggs,  stirring  in 
one  after  the  other  with  a  little  salt.  Previously  boil  the  farina  in  milk 
until  it  thickens ;  let  cool  a  little.  Beat  the  whites  of  the  eggs,  mix  and 
finally  add  the  grated  potatoes.  Dip  the  hands  into  flour  and  form  length- 
wise dumplings;  boil  in  salt  water  for  15  to  20  minutes. 


612    PREPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

BREAD(7) 

Drexel  Institute  Bread  Recipe. — 

Warm  milk  or  water 2  cupf uls 500  c.c 340  calories 

Salt 2  teaspoonfuls 8  gm. 

Sugar 2  «  20    «    82       " 

Lard  or  butter 1  tablespoonful. . . .   15    "    120 

Compressed  yeast 3^  cake 4    " 

Flour 4  pounds 2,000    «    6,500 

Put  the  water  or  milk,  salt,  sugar  and  fat  into  a  bowl.  Gradually  add 
the  yeast,  dissolved  in  warm  water,  and  the  flour.  When  stiff  enough  to 
handle,  turn  the  dough  on  a  floured  board  and  knead  until  soft  and  elastic. 
Put  it  back  into  the  bowl,  and  let  it  rise  in  a  warm  place  until  it  is  double 
its  bulk.  Then  divide  it  into  loaves  or  shape  into  biscuits.  Put  these 
into  the  pan  in  which  thej  are  to  be  baked,  cover  them  and  again  allow 
the  bread  to  rise  to  double  its  bulk.  Bake  loaves  one  hour  in  a  hot  oven. 
The  large  amount  of  yeast  allows  the  bread  to  be  made  and  baked  in  three 
hours.    This  recipe  makes  two  loaves. 

Brown  Bread. — 

Scalded  milk 3^  cupful 125  c.c 85  calories 

Water K       "     125" 

Salt 1  teaspoonful 4  gm. 

Butter H  tablespoonful. .. .     7    "   65       «* 

Lard M  "  ••••     7    "    65 

Molasses 2  tablespoonfuls. . .  30    "    148       « 

White  flour ^cupful 275    "    800       " 

Graham  flour 1       "     553    "    1,600 

Yeast ^  cake 

Lukewarm  water 34  cupful 60  c.c . 

Take  the  above  ingredients  and  sufficient  Graham  flour  to  knead,  dis- 
solving the  yeast  in  the  lukewarm  water.  Prepare  the  same  as  white 
bread.  Instead  of  Graham  flour,  equal  parts  of  Graham  flour  and  white 
flour  may  be  used  in  kneading. 

Nut  Brown  Bread. — The  same  as  preceding,  with  one  cupful  of  nuts 
chopped  and  added. 

Whole-wheat  Bread. — 

Yeast 34  cake 1  gm. 

Lukewarm  water 1  tablespoonful. ...   15  c.c. 

Hot  water 3^  cupful 125   " 

Milk 3^      "     125   " 85  calories 

Salt 3^  teaspoonful 2  gm. 

Whole-wheat  flour 1  cupful 553    «    1,624       " 


BREAD  613 

Dissolve  the  yeast  in  the  lukewarm  water.  Pour  the  hot  water  over 
the  milk,  and  when  lukewarm  add  the  yeast  and  salt.  To  this  add  the 
flour,  and  beat  for  five  minutes.  Cover  and  allow  this  to  stand  in  a  warm 
place  for  two  hours  and  a  half.  Then  add  the  whole-wheat  flour  gradually, 
mixing  the  mass  until  it  can  be  kneaded.  Knead  until  elastic ;  shape  and 
place  in  baking  pans.  Cover  and  allow  to  stand  in  a  warm  place  until 
it  doubles  its  bulk.  Prick  the  top  with  a  fork,  and  bake  for  one  hour. 
The  oven  should  not  be  hot  as  for  white  bread. 

Pulled  Bread — Use  bread  made  with  water.  Make  into  long  loaves, 
and  as  soon  as  baked  take  ofl"  the  crust.  Pull  into  stick-shaped  pieces  and 
brown  slightly  in  a  slow  oven. 

Zwieback. — Cut  stale  bread  in  slices  and  place  in  the  oven  and  allow 
to  remain  until  the  slice  is  colored  golden  brown.  Zwieback  is  a  particu- 
larly desirable  food  for  infants  and  invalids. 

Bran  Muffins  for  Constipation  (Musser  and  Piersol). — 

Bran  flour 2  cupfuls 500  gm 100  calories 

Wheat  flour 2       «      1,000    "    3,200       « 

Buttermilk 1  cupful 250  e.c 80       « 

Molasses 4  tablespoonfuls.  ...  60  gm 200       " 

Salt a  little 

Bake  in  mufiin  pans  (one  to  be  taken  at  each  meal). 

Graham  Bread  (Pattee)(8). — Make  the  same  as  whole-wheat  bread, 
adding  two  tablespoons  of  sugar  or  molasses.  Make  a  batter  with  white 
flour,  using  three  or  four  cups,  then  use  whole  wheat  or  graham  flour.  Let 
rise  longer  than  for  white  bread,  and  put  immediately  into  pans  without 
second  kneading.  Bake  in  a  hot  oven  from  forty-five  minutes  to  one  hour, 
depending  upon  size  of  loaves.  If  hard  crust  is  desired,  remove  from  pans 
and  cooi  in  a  draft  of  air.  For  soft  crust,  before  bread  cools,  roll  it  in  a 
clean  cloth. 

Note, — Omit  sweetening  if  desired. 

White  Gems  (Pattee). — 

Flour 2  cups 550  gm 1,600  calories 

Salt 1  teaspoonful . . . 

Rumford  baking  powder 4  teaspoonfuls. . . 

Butter 2  tablespoonfuls. 

Sugar 2  " 

Eggs 2  (whole) 

Milk 1  cupful 250  c.c . 

139 


4  « 
16  « 
30  "  

240 

40  "  

160 

50  «  

160 

550  c.c 

170 

614    PREPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

Sift  dry  ingredients  into  mixing  bowl,  add  melted  butter,  and  rub  it 
in  with  tips  of  fingers.  Add  the  well-beaten  eggs  and  the  milk  gradually 
and  beat  all  well  together.  Have  gem  pans  well  greased  and  heated;  fill 
two-thirds  full,  and  bake  in  a  very  hot  oven  fifteen  or  twenty  minutes. 
Put  a  little  melted  butter  on  each  gem  before  putting  it  into  the  oven. 
They  are  sufficiently  cooked  when,  if  tested  with  a  fine  washed  knitting 
needle,  it  comes  out  dry. 

Commeal  Gems  (Pattee). — 

Flour 1  cupful 265  gm 800  calories 

Commeal H      "     130    "    380 

Sugar M      "     100    "    400 

Rumford  baking  powder 4  teaspoonfuls 16    " 

Salt Kteaspoonful 2    " 

Egg 1  (whole) 50    "    80 

Milk 1  cupful 250  c.c 170 

Melted  butter 1  tablespoonful. ...   15  gm 120       " 

Sift  dry  ingredients  into  mixing  bowl,  add  the  milk  and  well-beaten 
egg  and  the  melted  butter.  Put  into  well-greased  hot  gem  pans  and  cook 
in  a  quick  oven. 

TOAST  (Pattee) 

In  the  ordinary  cooking  of  a  loaf  of  bread,  the  starch,  in  the  outer 
layer,  is  changed  into  dextrin,  which  gives  the  crust  its  sweet  flavor. 
Slices  of  bread  toasted  undergo  a  similar  change.  Bread  is  toasted  not 
merely  to  brown  it,  but  to  take  out  all  the  moisture  possible,  so  that  it  may 
be  more  thoroughly  moistened  with  the  saliva,  and  thus  easily  digested ; 
also  to  give  it  a  better  flavor.  The  correct  way  to  make  toast  is  to  use 
stale  bread  cut  in  uniform  slices,  and  to  dry  it  thoroughly  before  brown- 
ing. Toast  which  is  prepared  in  this  way,  even  if  moistened  with  milk 
or  water,  may  be  very  easily  and  thoroughly  acted  upon  by  the  digestive 
fluids. 

Milk  Toast  (Pattee). — Put  a  cup  of  rich  milk  in  a  saucepan  and 
place  it  on  the  stove.  While  it  is  heating,  toast  three  slices  of  bread  to 
a  delicate  brown,  and  put  them  into  a  covered  dish.  When  the  milk  is 
scalding  hot,  season  it  with  a  saltspoon  of  salt,  and  pour  it  over  the  toast. 
This  furnishes  888  calories. 

Note. — A  little  butter  may  be  spread  on  each  slice  before  the  milk  is 
added,  but  it  is  a  more  delicate  dish  without  it. 


CEREAL    FOODS  615 

Cream  Toast  (Pattee). — 

Butter 3^  tablespoonful. ...     7  gm 80  calories 

Flour y^  "  ....     7    «    50       « 

Salt K  saltspoon 1    " 

Cold  water 1    tablespoonful. ...   15  c.c. 

Milk M  cup 125   " 80       « 

Toast 13^  slices 37  gm 75 

Scald  milk.  Mix  flour  and  salt  and  add  the  cold  water  gradually, 
making  a  smooth,  thin  paste.  Add  to  scalded  milk ;  cook  in  double  boiler 
twenty  minutes,  stirring  constantly  until  it  thickens.  Add  butter.  Pour 
over  toast  and  serve  hot  on  hot  platter. 

CEREAL    FOODS 

Either  the  gi'ain  itself  or  the  specially  prepared  flour  may  be  used. 
When  the  grains  are  used  they  should  be  spread  on  a  clean  table  and  all 
foreign  substances  removed.  If  the  whole  grains  be  used,  it  is  well  to 
wash  them  after  picking  them  over,  with  two  or  three  changes  of  cold 
water. 

Cereals  are  best  cooked  in  a  double  boiler.  The  lower  part  should  be 
filled  about  one-third  full  of  water,  and,  if  more  is  added  during  the 
cooking,  it  should  always  be  boiling  hot.  The  cereal  should  be  cooked 
over  the  fire  for  ten  or  fifteen  minutes.  The  water  should  be  boiled  first 
and  then  salted.  The  cereal  is  added  gradually,  and  the  whole  stirred  to 
prevent  it  from  burning.  It  should  then  be  placed  in  a  double  boiler  and 
steamed  until  thoroughly  cooked.  Cereals,  like  other  starchy  foods,  re- 
quire thorough  cooking.  Most  recipes  allow  too  short  a  time.  Oatmeal, 
especially,  develops  a  better  flavor  if  cooked  for  throe  hours  or  more,  and 
it  is  better  when  it  is  prepared  the  day  before  and  reheated  when  used. 
It  sliould  be  just  thin  enough  to  pour  when  taken  out  of  the  boiler,  and 
when  cooled  should  form  a  thin  jelly. 

Any  cereal  mush  may  be  thinned  with  water,  milk  or  cream  and  made 
into  a  gruel,  or  the  gruel  may  be  made  directly  from  the  grain  or  flour. 
Gruels  should  be  thin,  not  too  sweet  nor  too  highly  flavored,  and  served 
very  hot.  Milk  gruels  should  be  made  in  a  double  boiler.  Gruels  may 
be  made  more  nutritious  by  the  addition  of  whipped  ^^ig^  either  the  white 
or  yolk  or  both,  and  the  various  concentrated  food  products. 

When  cereal  flours  are  used  the  flour  should  be  nibbed  to  a  smooth 
paste  with  a  little  cold  water  and  added  slowly  to  boiling  water,  stirring 
constantly  until  it  is  thoroughly  mixed. 

Cereals  supply  actual  digestible  nutriments  to  the  body  more  cheaply 


616    PKEPAKATION  OF  SPECIAL  BEVEKAGES  AND  FOODS 

than  any  other  class  of  foods,  except  the  dried  legumes.  All  animal 
foods,  especially  meats,  are  more  expensive,  even  as  sources  of  protein, 
than  cereals.  A  glance  at  their  composition  shows  that  they  are  chiefly 
fuel  foods,  because  of  their  high  carbohydrate  content.  Their  cost  varies 
with  the  cost  of  labor  and  fuel  in  preparing  the  foods.  The  compara- 
tively expensive  ready-to-eat  breakfast  foods  do  not  yield  any  extra  nutri- 
tive value.  Their  only  advantages  are  pleasant  flavors  and  ease  of  serving. 
Cereal  products  yield  on  the  average  between  1,600  and  1,700  calories 
per  pound. 

LENGTH  OF  TIME  TO  COOK  CEREALS 

Cornmeal  mush Boil  10  minutes,  then  steam  for  3      hours  or  more 

Oatmeal «    10         "  "         "       "43^       "       «      " 

Irish  oatmeal "10         "  "         "       "8  «       «      " 

Wheatena "10         "  «         «       «  2>^      "       «      « 

Gluten  mush "    30         « 

Steamed  rice "    1  hour 

Boiled  rice "    20  minutes,  or  until  soft. 

GKUELS 
Oatmeal  Gruel. — 

Granulated  oatmeal 2  tablespoonfuls.  ...  45  gm 184  calories 

Table  salt 1  saltspoonful 2    " 

Sugar 1  teaspoonf ul 10    "  41        " 

Water  (boiling) 1  cup 250  c.c. 

Milk 1    « 300   " 216 

Mix  the  oatmeal,  salt  and  sugar  together,  and  pour  on  the  boiling 
water.  Cook  for  thirty  minutes,  then  strain  through  a  fine  wire  strainer 
to  remove  the  hulls.  Place  again  on  the  stove,  add  the  milk  and  heat  just 
to  the  boiling  point.     Serve  hot.     This  gruel  furnishes  425  calories. 

Flour  Gruel. — Proceed  as  in  making  oatmeal  gruel,  using,  instead, 
two  tablesjioonfuls  of  wheat  flour.  Flavor  with  lemon  juice,  cinnamon, 
nutmeg  or  vanilla.     Energy  value  about  400  calories. 

Farina  Gruel. — Proceed  as  in  making  oatmeal  gruel,  using,  instead, 
two  tablespoonfuls  of  farina,  and  boil  but  ten  minutes  before  adding  the 
milk.     Energy  value  about  275  calories. 

Imperial  Granum  Gmel — As  in  the  preceding,  but  use  Imperial  Granum 
instead  of  farina.     Same  caloric  value. 

Cracker  Gruel  No.  1 

Cracker  crumbs 2  tablespoonfuls.  ...  45  gm 175  calories 

Use  the  cracker  crumbs  and  proceed  as  above.  Cook  only  two  or  three 
minutes  and  do  not  strain. 


CEREAL    FOODS  617 

Cracker  Gruel  No.  2  (l)rexel  Institute). — Brown  the  crackers,  and 
reduce  to  a  powder  by  means  of  a  rolling  pin.  Add  three  tablespoonfuls 
of  the  powdered  crackers  to  half  a  cupful  of  milk  and  half  a  cupful  of 
boiling  water.  Cook  for  ten  minutes,  then  add  one-fourth  of  a  teaspoon- 
ful  of  salt  and  serve.     Energy  value  about  250  calories. 

Racahout  des  Arabes  (Gautier)(9). — This  is  a  French  preparation 
with  a  chocolate  flavor  which  makes  a  most  delicious  giniel.  A  home- 
made racahout  may  be  made  as  follows : 

Cocoa 1  pound 453  gm 2,320  calories 

Confectioner's  powdered  sugar .  .  1      "     453    "    1,875       " 

Rice  flour 1      «     453    «   1,630 

Arrowroot  flour 2  ounces 56    "   60       " 

Sugar  of  milk 2      "     56    "   224 

Mix  the  above  ingredients  thoroughly.  Follow  the  directions  given 
for  farina  gruel. 

Flour  Ball. — Tie  half  a  pint  of  flour  in  a  square  of  fine  cheesecloth, 
making  a  very  tight  ball.  Place  this  in  a  pot  of  boiling  water  and  cook 
for  four  or  five  hours.  After  taking  out  of  the  cloth,  peel  off  the  outside 
and  grate  the  hard  ball.  Dry  in  the  oven  and  keep  in  a  covered  jar. 
This  is  useful  for  making  gruels  for  diluting  milk  for  infants. 

Flour  Ball  Gruel — Proceed  as  for  oatmeal  gruel,  using  two  teaspoon- 
fuls  of  the  above  grated  flour  rubbed  up  in  one-half  cup  cold  water,  and 
stirring  into  a  pint  of  boiling  water.  Cook  this  for  ten  minutes.  This 
will  furnish  15  calories  to  100  c.c. 

Meal  Soup 

Wheat  flour 2  tablespoonfuls.  . .  60  gm 45  calories 

Water J^  pint 250  c.c. 

Milk H    "  250    «  170       « 

This  is  prepared  by  browning  the  wheat  flour  in  a  clean  frying  pan, 
stirring  continuously.  The  water  and  milk  are  brought  to  a  boil,  and  a 
heaping  tablespoonful  of  the  browned  flour  is  blended  with  water  and  then 
stirred  into  the  mixture. 

Commeal  Gruel  No.  1  (Pattee). — 

Cornmeal 2  tablespoonfuls.  . .  60  gm 45  calories 

Flour 1  "  ...  30    "    25 

Sugar 1  teaspoonful 10    "    41 

Salt 1  tablespoonful  ...     4    « 

Hot  water 1  quart 500  c.c. 

Milk 1  cupful 250    «  170       « 


618    PllEPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

Proceed  as  in  making  oatmeal  gruel,  cooking  in  a  double  boiler  for 
three  hours, 

Cornmeal  Gruel  No.  2 — Take  a  tablespoonful  of  commeal  and  moisten 
with  a  little  cold  water.  Stir  this  into  a  pint  of  boiling  water  to  which 
a  pinch  of  salt  has  been  added.  Cook  for  three  hours  in  a  double  boiler, 
or  for  thirty  minutes  directly  over  the  fire.  In  the  latter  case  it  must  be 
stirred  constantly. 

Gluten  Gruel  (Drexel  Institute). — 

Gluten  flour 1  tablespoonful. ...  30  gm 30  calories 

Cold  water ^  cupful 125  c.c. 

Boiling  salted  water 1      "     250    « 

Mix  the  gluten  flour  with  the  cold  water  and  stir  this  into  the  boiling 
salted  water.  Cook  directly  over  the  fire  for  fifteen  minutes,  then  add  one 
clove  and  cook  over  boiling  water  for  a  half  hour. 

Barley  and  Oatmeal  Jelly. — 

From  the  Grain. — Prepare  the  grain  as  directed  for  barley  water. 
Use  from  four  to  six  tablespoonfuls  of  grain  to  the  quart  of  water.  Boil 
thoroughly  for  several  hours  until  the  grain  is  thoroughly  cooked.  Strain 
and  cool.  The  jelly,  when  hot,  should  be  just  thick  enough  to  pour.  This 
furnishes  about  28  calories  to  100  grams. 

From.  Prepared  Flours. — Use  two  tablespoonfuls  of  the  flour  to  a  pint 
of  water.    Boil  from  fifteen  to  thirty  minutes  and  strain. 

Egg  Gruel. — 

Hot  beef  broth 1  cupful 250  c.c 36  calories 

Egg 1  (whole) 50  gm 80       " 

Salt 3^  teaspoonf ul 2    " 

Take  the  beef  broth  made  with  "Soluble  Beef,"  the  egg  and  salt.  Beat 
the  white  and  the  yolk  of  the  egg  separately,  add  the  hot  beef  broth  grad- 
ually to  the  yolk,  stirring  continually.  Whip  the  white  to  a  stiff,  dry 
froth  with  the  salt,  and  beat  it  into  the  hot  broth.  Return  to  the  double 
boiler  and  reheat.     Serve  very  hot. 

Barley  Gruel  with  Beef  Extract. — 

"Soluble  Beef" ]/2  teaspoonful 2  gm 20  calories 

Hot  water 2  cupfuls 500  c.c. 

Barley  flour 1  tablespoonful. ...   20  gm 22       * 

Salt 1  saltspoonful 2    " 

Dissolve  the  beef  in  the  hot  water,  and  mix  the  flour  and  salt  together 
with  a  little  cold  water.  Pour  the  boiling  stock  on  the  flour  and  cook  for 
ten  minutes.    Strain  and  serve  very  hot. 


CEIIEAL    FOODS  619 

Barley  Meal  Gruel  (Watson). — 

Barley  meal 1  dessertspoonful . .   10  gm 15  calories 

Milk 3^  pint 250  c.c 170 

Butter Small  piece 15  gm .120       « 

Sugar 1  teaspoonful 10    «   41       " 

Salt M  "  1    " 

Alix  the  milk  very  gradually  with  the  meal,  stirring  until  quite 
smooth.  Take  a  small  lined  saucepan,  and  after  rinsing  with  cold  water 
pour  the  barley  and  milk  into  it.  Stir  constantly  over  the  fire  until  boil- 
ing, let  it  boil  ten  minutes,  season  and  serve  very  hot. 

Port  Wine  Gruel  (Watson). — Make  a  gruel  with  oatmeal  or  barley 
meal  and  water,  then  thin  it  down  with  a  glass  of  port  wine;  heat  thor- 
oughly, but  do  not  boil  again. 

Arrowroot  Gruel  (Individual  Rule)   (Pattee). — 

Arrowroot 2  teaspoonfuls 25  gm 26  calories 

Cold  water 2  tablespoonfuls.  . .   15  c.c. 

Boiling  milk 1  cupful 250    "   170 

Salt a  pinch 1  gm. 

Sugar  (lemon  juice,  wine  or  brandy 

as  required) 3^  teaspoonful 10    "   20       " 

Blend  the  arrowroot  and  cold  water  to  a  smooth  paste.  Add  to  the 
boiling  water  or  milk.  Cook  in  double  boiler  two  hours.  Add  salt. 
Strain  and  serve  hot.  Arrowroot  is  the  purest  form  of  starch,  and  bene- 
ficial in  cases  of  diarrhea  if  not  given  too  hot. 

Barley  Gruel  (Individual  Rule)   (Pattee). — 

Barley  flour 1  tablespoonful. ...  30  gm 40  calories 

Cold  milk 2  tablespoonfuls.  . .  30  c.c 24       " 

Scalded  milk .'.  1  cupful 250    «   170       "      < 

Salt. 

Blend  the  barley  flour  with  the  cold  milk  and  stir  into  the  scalding 
milk.  Cook  in  double  boiler  twenty  minutes.  Season  with  salt  to  taste, 
and  add  sugar  if  desired.     Strain. 

Flour  Gruel  or  Thickened  Milk  (Individual  Rule)  (Pattee). — 

Scalded  milk ^  cupful 188  c.c 128  calories 

Cold  milk H      "      ■ 62    «   42       " 

Flour H  tablespoonful. ...   15  gm 20       " 

Salt speck 1    " 

Raisins 1  dozen 8    "   20 

Mix  the  flour  with  the  cold  milk  to  make  a  smooth  mixture,  and  stir 
into  the  scalding  milk.     Cook  in  a  double  boiler  one-half  hour  or  on  back 


620    PKEPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

of  stove  in  a  saucepan.  Stone  and  quarter  the  raisins,  then  add  water 
enough  to  cover.  Cook  slowly  until  water  has  all  boiled  away.  Add  to 
gruel  just  before  serving.  Add  salt.  Strain  and  serve,  or  it  may  be  eaten 
with  the  raisins  in  it.  This  gruel  may  also  be  made  without  the  raisins. 
Never  use  raisins  in  bowel  troubles. 

Oatmeal  Gruel  (Watson). — 

Coarse  oatmeal 3^  cupful 100  gm 201  calories 

Water 2  cupfuls 500  c.c. 

Salt M  teaspoonful 2  gm. 

Milk H  cupful 125  c.c 85       « 

Pound  the  oatmeal  in  a  mortar  until  it  is  mealy,  then  put  it  into  a 
tumbler  and  fill  it  with  cold  water.  Stir,  and  pour  off  the  mealy  water 
into  a  saucepan.  Fill  tumbler  again,  stir  and  pour  off,  and  repeat  until 
the  above  quantity  of  water  is  exhausted.  Boil  the  oatmeal  water  thirty 
minutes,  stirring  frequently.  Season  with  salt  to  taste.  Thin  with  milk 
or  cream  to  desired  consistency. 

EGGS 

Eggs  are  a  very  concentrated  food,  one  egg  being  equal  in  nutriment 
to  40  grams,  1^  ounces  of  fat;  or  two  eggs,  equal  to  about  5  ounces  of 
cow's  milk.  The  digestibility  of  eggs  is  influenced  by  the  mode  of  prepa- 
ration. They  are  a  rather  fatty  food  and  contain  fat  and  albumin  in 
about  equal  proportion,  5  to  6  per  cent.  Egg  albumin  is  almost  entirely 
peptonized  in  the  stomach,  and  the  fat  of  the  yolk  is  almost  completely 
split  up  before  reaching  the  small  intestine.  Hard-boiled  eggs  are  dif- 
ficult to  digest  by  weak  stomachs,  and  may  even  be  the  cause  of  painful 
sensations  for  the  reason  that  the  coarse  albumin,  which  is  not  readily 
dissolved,  irritates  the  sensitive  mucous  membrane  of  the  stomach ;  if 
taken  in  pulverized  form  they  will  cause  no  disturbance.  Omelet  souffle 
and  fried  eggs  are  difficult  of  digestion,  while  soft-boiled  eggs  and 
poached  eggs  are  more  easily  and  readily  digested.  Eggs  for  the  invalid 
or  convalescent,  whether  partaken  of  raw  or  cooked,  should  be  perfectly 
fresh.  Eggs  are  a  very  nourishing  food  for  children  on  account  of  the 
lecithin  and  phosphates. 

Eggs  are  exceedingly  valuable  as  a  food  for  invalids.  They  should 
not  be  kept  with  any  article  of  food  having  an  odor,  as  they  absorb  such 
odors  and  the  taste  is  thereby  impaired.  Stale  eggs  will  not  sink,  and  if 
held  to  a  bright  light  they  show  a  dark  spot.    The  yolk  of  an  egg  that  has 


EGGS  621 

been  broken  may  be  kept  fresh  by  placing  it  (unbroken)  in  a  cupful  of 
cold  water.  This  should  be  set  in  a  cool  place.  This  will  keep  it  fresh 
for  tweiity-four  hours  or  more.  Eggs  and  all  other  albuminous  food 
should  be  cooked  at  as  low  temperatures  as  possible,  in  order  to  avoid 
rendering  them  tough. 

Eggs  are  best  cooked  in  the  shell  as  follows : 

Soft-cooked  Eggs — Place  in  a  pint  of  boiling  water,  remove  from  the 
fire,  and  allow  to  stand  for  eight  or  ten  minutes.  If  the  egg  is  very  cold 
to  start  with,  it  will  take  a  little  longer. 

Hard-cooked  Eggs. — Place  in  water,  bring  to  a  boil,  and  then  set  on 
the  back  part  of  the  stove  for  twenty  minutes.  Eggs  should  be  served 
as  soon  as  cooked,  and  the  dishes  should  be  warmed  and  ready.  One 
ordinary  egg,  50  grams,  80  calories. 

How  to  Make  an  Omelet  (Watson). — Break  the  eggs  into  a  bowl,  add 
salt  and  pepper,  and  beat  them  with  a  fork  for  about  a  minute,  not  longer 
as  a  rule.  When  the  eggs  are  sufiiciently  beaten  they  "run"  off  the  fork 
in  a  homogeneous  liquid,  without  any  glutinous  appearance.  It  is  not 
necessary  to  beat  for  several  minutes,  with  the  idea  that  the  more  the 
eggs  are  beaten  the  lighter  the  omelet.  ♦  This  is  a  great  mistake,  as  too 
much  beating  causes  eggs  to  lose  their  consistency.  It  is,  however,  better 
to  beat  too  much  than  too  little.  Place  the  pan  on  the  fire  to  warm  it,  and 
put  in  a  small  piece  of  butter — about  the  size  of  a  hazel-nut  for  an  omelet 
of  2  or  3  egg-s.  Add  the  contents  of  the  bowl  when  the  butter  steams.  If 
this  precaution  is  taken,  the  omelet  will  not  catch,  as  the  high  temperature 
of  the  butter  isolates  the  eggs.  It  is,  therefore,  a  mistake  to  shake  the 
eggs  directly  they  are  poured  into  the  pan.  But  a  second  or  two  later,  the 
fork  must  be  passed  round  the  sides  of  the  pan  to  loosen  the  eggs,  and 
then  they  are  worked  in  all  directions  with  the  back  of  the  fork  as  if  they 
were  scrambled.  When  they  are  sufficiently  cooked,  they  look,  in  fact, 
almost  like  scrambled  eggs ;  but  now  the  omelet  is  shaken  on  to  one  side 
of  the  pan,  and  with  the  fork  one-half  is  folded  on  the  other  and  slid  on 
to  the  dish.  The  shape  of  the  omelet  is  thus  obtained  without  difficulty, 
and  the  heat  of  one-half  just  finishes  the  cooking  of  the  other  as  it  rests 
upon  it. 

Omelet  Souffle     (Sweet)   (Watson).— 

White  sugar 1  tablespoonful. ...  40  gm 160  calories 

Salt a  pinch 1    " 

Eggs 2  (whole) 100    «   160 

Powdered  vanilla a  little K    " 


622    PKEPARATION  OF  SPECIAL  BEVEKAGES  AND  FOODS 

Take  two  bowls ;  put  into  one  of  them.  1  teaspoonf ul  of  white  sugar, 
into  the  other  a  pinch  of  salt.  Break  2  eggs,  separate  the  yolks,  and  drop 
one  yolk  at  a  time  into  the  bowl  containing  the  sugar ;  whip  them  well  with 
a  wooden  spoon  until  they  become  creamy  like  mayonnaise.  Add  a  little 
powdered  vanilla  to  another  one-half  teaspoonful  of  sugar,  and  mix  with 
the  yolks.  Put  the  whites  of  the  eggs  into  the  bowl  containing  the  salt,  and 
whip  into  a  stiff  froth.  Mix  with  the  yolks  as  lightly  as  possible,  and 
pour  the  contents  into  a  buttered  dish  in  the  shape  of  a  pyramid.  Cover 
it  with  sifted  sugar  and  leave  it  for  three  or  four  minutes  on  the  side  of 
the  sto\e.  Then  put  it  into  the  oven  for  ten  to  twelve  minutes,  turning 
the  dish  occasionally  to  color  it  on  all  sides.  Make  two  or  three  incisions 
with  a  knife,  and  serve  immediately.  This  omelet  must  be  eaten  as  soon 
as  it  is  cooked,  or  it  loses  both  its  shape  and  its  delicacy. 

Snowball  Eggs  (Watson). — 

Eggs 3  (whole) 150  gm 240  calories 

Powdered  white  sugar 1  tablespoonful. ...  40    " 160       " 

Milk 1  pmt 250  c.c 170 

Rind  of  lemon  or  vanilla 
Sugar  to  taste 

Place  1  pint  of  milk  in  a  saucepan  on  the  fire  with  the  rind  of  a  lemon 
or  a  little  vanilla,  and  sufficient  white  sugar  to  sweeten.  Break  3  eggs, 
separating  the  white  from  the  yolk.  Beat  the  whites  of  the  eggs  into  a 
stiff  froth,  adding  a  small  pinch  of  salt.  When  sufficiently  stiff,  add  the 
sugar  and  mix  briskly.  Take  a  teaspoonful  of  this  mixture  and  throw  it 
into  the  boiling  milk  in  the  saucepan ;  turn  it  three  minutes  later,  remove 
it  with  a  skimmer.  Take  as  many  spoonfuls  of  white  of  egg  as  remain 
and  cook  them  in  a  similar  manner,  three  or  four  at  a  time.  (If  the  white 
has  been  beaten  sufficiently  stiffly,  when  cooked  each  spoonful  will  be  a 
compact  mass.)  Arrange  the  snowballs  in  a  pyramid  on  a  dish.  Pour  the 
remainder  of  the  milk  from  the  saucepan  into  the  yolks  of  the  eggs ;  put 
this  mixture  into  another  saucepan  on  the  fire,  stir  it  constantly  with  a 
spoon,  and  let  it  thicken  without  boiling.  Pass  it  through  a  strainer,  and 
when  cold  pour  it  over  the  snowballs  in  the  dish. 

Prairie  Oyster  (Watson). — 

Fresh  egg 1  (whole) 50  gm 80  calories 

Vinegar 1  tablespoonful. ...   15  c.c. 

Put  the  vinegar  into  a  small  cup  and  break  the  egg  into  it.  Serve  at 
once.  This  is  a  very  digestible  way  of  serving  an  egg,  and  it  is  very  cool 
and  refreshing. 


EGGS  623 

Egg  Drink  (Watson). — 

Egg 1  (whole) 50  gm 80  calories 

Milk 1  teacup 250  c.c 170 

Sugar 1  teaspoonful 10  gm 41        " 

Sherry  wine 1  tablespoonful. ...   15  c.c 21       " 

Beat  lip  the  eggj  add  to  it  the  wine  and  sugar,  beat  together  with  a 
fork  slightly,  and  strain  through  a  fine  wire  strainer.  Heat  the  milk  in 
a  small  saucepan,  and  when  almost  boiling  pour  it  on  to  the  egg,  stirring 
all  the  time.  Serve  hot.  This  can  be  made  without  wine,  flavoring  with 
cinnamon  or  lemon  juice.  The  yolk  of  the  egg  only  may  be  used,  and  soda 
water  may  take  the  place  of  milk. 

Poached  Egg  (Watson). — 

Egg 1  (whole) 50  gm 80  calories 

Boiling  water 1  cupful 250  c.c. 

Lemon  juice 1  teaspoonful 15    " 

Salt a  pinch 1  gm. 

Toast 3^  shce 10    "    31 

Break  the  egg  into  a  cup,  keeping  the  yolk  whole.  To  a  small  sauce- 
pan of  boiling  water  add  a  pinch  of  salt  and  a  squeeze  of  lemon  juice. 
Draw  the  water  to  the  side,  and  when  just  off  the  boil  slip  the  egg  care- 
fully into  it.  Cook  slowly  for  three  minutes,  when  the  white  should  be 
quite  set.  Lift  it  out  with  a  small  fish  slice  or  perforated  spoon,  and  trim 
off  any  ragged  edges  of  white.  Place  on  a  square  of  newly-made  toast, 
and  serve  at  once. 

If  required,  this  egg  can  be  made  richer  by  being  served  on  buttered 
toast,  or  by  having  a  little  hot  cream  poured  over  it.  A  poached  egg 
served  on  2  tablespoonfuls  of  carefully  prepared  spinach  is  also  a  very  nice 
dish. 

Rumbled  Egg  (Watson). — 

Egg 1  (whole) 50  gm 80  calories 

Milk 1  tablespoonful 15  c.c 15       " 

Pepper  and  salt a  pinch  of  each ....     1  gm. 

Butter 14  ounce 7    "    60 

Toast  (dry) a  piece 10    "    31 

Heat  the  milk  in  a  small  saucepan.  Pour  into  the  hot  milk  the  egg 
beaten  up  in  a  cup  with  pepper  and  salt.  Stir  quickly  over  the  fire  until 
it  begins  to  thicken,  then  remove  it  from  the  fire  and  continue  stirring 
until  it  forms  a  creamy  mixture.      Put  on  a  piece  of  newly-made  toast, 


624    PEEPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

and  serve  at  once.     If  cooked  too  long,  or  allowed  to  stand,  it  becomes 
leathery  and  indigestible. 

Poached  Eggs  with  Cheese  (Watson). — 

Eggs 4  (whole) ....  .200  gm 320  calories 

White  sauce 1  gill 

Butter 7  ounces 30    "   240 

Breadcrumbs 3  tablespoonfuls.  . .  65    "    250       " 

Pepper  and  salt a  pinch  of  each ...     1    " 

Grated  cheese 3  tablespoonfuls.  . .  60    "    273 

Butter  a  flat  dish  and  sprinkle  it  with  half  the  breadcrumbs  and 
cheese.  Poach  the  eggs  and  place  them  on  the  top.  Then  pour  over  the 
sauce,  and  put  the  rest  of  the  cheese  and  breadcrumbs  on  the  top.  Lay  on 
a  few  small  pieces  of  butter,  and  place  in  a  hot  oven  to  melt  the  cheese 
and  lightly  brown  the  top. 

FISH 

Fish  contains  a  large  quantity  of  protein  and  gelatinous  substances. 
In  the  dietary  of  patients  suffering  from  gastric  disturbances,  fish  such 
as  eel,  salmon  and  herring  should  be  excluded,  the  first  two  on  account 
of  the  excess  of  fat  contained,  and  the  last  on  account  of  its  excess  in 
salts.  The  nutritive  value  of  fish,  generally  speaking,  is  about  equal  to 
that  of  veal,  and  in  the  uric  acid  diathesis,  fish  is  better  borne  than  meat. 
Oysters  are  less  digestible  than  is  commonly  believed (10). 

Baked  Fish  (Watson).— 

Uncooked  butterfish J^  pound 113  gm 200  calories 

Breadcrumbs 2  tablespoonfuls.  . .  45    "   175       " 

Pepper,  salt  and  a  httle  lemon 
juice 

Egg 1  (whole) 50    «    80       " 

Milk i^gill 125  c.c 85       « 

Butter H  ounce 15  gm 120 

Grease  a  small  pie  dish  with  a  little  of  the  butter.  Have  the  fish  free 
from  skin  and  bone,  and  cut  it  into  neat  pieces.  Lay  half  of  these  pieces 
in  the  bottom  of  the  pie  dish,  sprinkle  over  them  a  little  white  pepper, 
salt  and  a  squeeze  of  lemon  juice,  and  then  put  on  a  layer  of  breadcrumbs. 
Next,  put  in  the  rest  of  the  fish,  seasoning  and  more  crumbs.  Beat  up 
the  egg  in  a  basin,  add  the  milk  to  it,  and  strain  this  into  the  dish.  Put 
the  rest  of  the  butter  in  small  pieces  on  the  top  and  wipe  round  the  edges 
of  the  dish.    Bake  in  the  oven  until  nicely  browned. 


FISH  625 

Steamed  Sole  or  Whiting  (Watson). — 

Whiting 1  pound 453  gm 700  calories 

Butter 1  ounce 30    "    240 

Flour 1      «     30    "    22 

Milk 1  giU 125  c.c 85       " 

Lemon slice 

Skin  and  fillet  the  tish,  wash  and  dry  the  fillets,  and  put  them  in  a  jam 
pot  which  is  placed  in  a  saucepan  half  full  of  boiling  water.  Cover  tightly 
and  let  boil  for  ten  minutes.  Mix  the  butter  with  the  flour  in  a  saucepan 
over  the  fire.  Add  the  milk  and  liquor  from  the  fish,  and  cook  for  ten 
minutes,  stirring  well.  Pour  this  sauce  over  the  fillets  and  garnish  with 
the  lemon. 

Steamed  Fish  (Watson). — 

Haddock,  whiting  or  sole 1  pound,  filleted. . . . 453  gm 340  calories 

Salt  and  white  pepper a  pinch  of  each 1    " 

Butter 1^  ounce 15    "    120 

Lemon  juice a  squeeze 

This  is  the  lightest  and  simplest  mode  of  cooking  fish  for  an  invalid. 
Cut  the  fillets  of  fish  into  neat-sized  pieces ;  grease  a  soup  plate  or  muffin 
dish  with  a  little  butter,  and  place  the  fish  on  this.  Sprinkle  it  with  a 
little  salt  and  white  pepper  if  this  is  allowed,  and  squeeze  over  it  some 
lemon  juice,  which  helps  to  keep  the  fish  firm  and  white.  Cover  with  a 
piece  of  greased  white  paper,  and  then  with  a  lid  or  basin.  Place  this 
over  a  pan  half  full  of  boiling  water,  seeing  that  the  plate  fits  well  on  the 
pan.  Keep  the  water  in  the  pan  boiling,  so  that  there  may  be  plenty  of 
steam,  and  cook  from  twenty  to  thirty  minutes,  until  the  fish  loses  its 
clear,  transparent  appearance  and  looks  quite  white.  If  the  pieces  are 
thick,  it  is  better  to  turn  them  while  cooking.  The  liquid  that  is  on  the 
plate  when  the  fish  is  cooked  is  the  juice  from  the  fish,  and  should  be 
served  v/ith  it.  Serve  with  a  little  plain  cold  butter  and  a  piece  of  plain 
bread  or  toast. 

Stewed  Fish  (Watson).— 

Filleted  fish,  whiting,   haddock, 

sole,  plaice 1  (whole)  2  pounds. . .  1,000  gm 1,400  calories 

Breadcrumbs 1  tablespoonful 22    "  80       " 

Chopped  parsley 1  teaspoonful 4    "   5       " 

Milk 1  gill 125  c.c 85       « 

Butter 1  ounce 30  gm 240       « 

Pepper  (white) a  pinch' 0.5  " 

Cold  water 1  gill 125  c.c. 


626    PHEPAKATION  OF  SPECIAL  BEVERAGES  AND  EOODS 

Wipe  the  fish  with  a  damp  cloth  and  cut  it  into  small,  neat  pieces. 
Rinse  out  a  lined  saucepan  with  water,  and  place  the  pieces  of  fish  in  the 
bottom.  Sprinkle  over  them  a  little  salt  and  white  pepper,  pour  in  the 
milk  and  water,  put  the  lid  on  the  pan,  and  let  the  fish  cook  slowly  by  the 
side  of  the  fire  until  it  is  ready,  which  will  be  in  about  fifteen  minutes. 
Do  not  overcook,  or  the  fish  will  be  hard.  Lift  out  the  pieces  of  fish  on 
to  the  plate  on  which  they  are  to  be  served,  and  keep  them  hot.  Add  the 
breadcrumbs  and  the  butter  to  the  water  and  milk  in  the  pan.  Stir  over 
the  fire  for  a  few  minutes  until  the  breadcrumbs  swell  and  thicken  the 
sauce.  Sprinkle  in  the  minced  parsley,  and  then  pour  this  sauce  over  the 
fish. 


Eish  are  allowable  for  old  people.  The  oily  fishes — such  as  salmon, 
herring,  mackerel — are  the  only  ones  that  are  apt  to  disagree  with  diges- 
tion, unless  taken  in  small  quantities.  In  addition  to  the  usual  methods 
of  boiling,  frying  and  baking  fish  already  described,  a  variety  of  dishes 
may  be  made  from  this  class  of  food  that  are  found  to  be  appetizing  as 
well  as  quite  satisfying. 

Fish  Baked  in  Batter  (Watson). — 

Uncooked  fish,  haddock  or  sole. .  ^  pound 113  gm 90  calories 

Flour 1  ounce 28    "    240 

Milk 3^  gill 65  c.c 45 

Egg 1  (whole) 50  gm 80 

Butter 3^  ounce 15    « .120       « 

Pepper,  salt  and  lemon  juice 

First  make  the  batter,  rub  the  flour  through  a  wire  sieve,  to  free  it 
from  lumps,  and  put  it  into  a  basin.  Beat  up  the  G^g  with  a  fork  and  add 
it  to  the  flour ;  beat  with  a  wooden  spoon  until  quite  smooth  and  free  from 
lumps.  Then  add  the  milk  and  beat  for  a  few  minutes  longer.  The  more 
the  batter  is  beaten  the  lighter  it  will  be. 

Have  the  fish  free  from  skin  and  bone,  and  cut  into  small  pieces.  Lay 
these  in  the  bottom  of  a  small  greased  pie  dish,  and  season  with  pepper, 
salt  and  a  squeeze  of  lemon  juice.  Pour  the  batter  over  them,  and  put 
the  butter  in  small  pieces  on  the  top.  Allow  this  to  stand  for  a  few 
minutes  before  cooking,  as  this  gives  time  for  the  flour  in  the  batter  to 
swell,  and  makes  it  lighter  when  baked.  Bake  in  a  quick  oven  from 
twelve  to  fifteen  minutes  until  well  risen  and  nicely  browned.  Serve  at 
once,  as  the  batter  quickly  falls. 


FISH  627 

Fish  Souffle  (Watson). — 

Uncooked  fish }/i  pound 113  gm 90  calories 

Butter K  ounce 15    «   120 

Flour M      "     '15    "   10       " 

Fish  stock  or  milk 3^  gill 65  c.c 45       " 

Eggs 2  (whole) 100  gm 160 

Pepper,  salt  and  lemon  juice. . .  .a  pinch  of  each 

First  make  a  panada  with  the  butter,  flour  and  fish.  This  is  done  by 
melting  the  butter  in  a  small  saucepan,  adding  the  flour  and  mixing  until 
it  is  smooth  with  a  wooden  spoon.  Then  pour  on  the  milk  or  fish  stock, 
and  stir  until  the  mixture  is  thick  and  free  from  lumps  and  leaves  the 
sides  of  the  pan  quite  clean. 

Scrape  the  fish  down  finely  with  a  knife.  Put  the  panada  into  a 
mortar  with  the  fish,  seasoning  and  yolks  of  eggs.  Pound  well  together 
and  rub  through  a  sieve.  Beat  up  the  whites  of  eggs  to  a  stiff  froth,  and 
stir  lightly  into  the  fish  mixture  with  an  iron  spoon.  Pour  into  a  greased 
basin,  which  should  be  only  half  full.  Cover  with  a  greased  paper.  Steam 
for  twenty  minutes.    When  firm,  lift  it  out  and  turn  out  on  a  hot  plate. 

Panned  Oysters  (Watson). — 

Oysters  (deep-sea) 6  (whole) 90  gm 44  calories 

Salt,  pepper a  pinch  of  each ...  1    " 

Butter y^  ounce 15    «   120 

Meat  stock 1  teaspoonf ul 4  c.c 4       " 

Lemon thin  slice 

Place  the  oysters  in  a  colander  and  pour  cold  water  over  them.  Drain 
for  ten  minues,  then  place  in  a  very  hot  iron  pan,  add  the  salt,  pepper, 
butter  and  meat  stock.  Cook  for  a  few  minutes  and  serve  the  oysters 
garnished  with  the  lemon. 

Broiled  Oysters  (Watson). — 

Oysters  (large) 6  (whole) 90  gm 44  calories 

Salt  and  cayenne  pepper a  pinch  of  each ...     1    " 

Heated  beef  juice 3^  ounce 15  c.c 15       " 

Melted  butter 3^      "     15    «   120 

Lay  the  oysters  on  a  board  and  dry  them,  season  with  the  salt  and 
cayenne  pepper.  Have  a  gridiron  thoroughly  heated,  place  the  oysters 
on  the  gridiron,  and  brown  them  on  both  sides.  Serve  on  a  very  warm 
plate  with  the  beef  juice  and  melted  butter  poured  around  them. 


628    PKEPARATIOJs^  OF  SPECIAL  BEVERAGES  AND  FOODS 

POULTRY 

The  flesh  of  poultry  or  barnyard  fowls  is  characterized  by  short  mus- 
cular fibers  and  a  minimum  amount  of  fat.  The  birds  coming  under  this 
classification  have  already  been  referred  to  at  length  in  the  chapter  on 
"Animal  Foods"  (Volume  I,  Chapter  XII,  page  296).  They  have  an 
abundance  of  white  flesh,  which  is  most  easy  of  digestion,  being  tender 
and  of  a  delicate  flavor.  A  young,  well-fed  chicken  is  the  most  digestible 
of  all  animal  foods.  Short-legged  fowls  are  more  delicate  in  flavor.  As 
for  age,  a  one-year-old  cock  will  be  found  too  tough  for  roasting  or  braiz- 
ing, and  only  suitable  for  stews  or  soups.  The  flavor  and  tenderness  of 
the  young  cockerel  are  greatly  improved  by  caponizing,  which  has  already 
been  described  in  the  reference  just  given. 

Chicken  Salad  (Pattee). — 

Cut  chicken 3^  pound .225  gm 465  calories 

Cut  celery 1  cup 250    «    85 

Nicelle  olive  oil 1  ounce   (2  table- 
spoonfuls) 28    «    121       « 

Salt 1  saltspoonful 1    " 

Pepper K  "  0.5" 

Vinegar 1  tablespoonful. ...   15  c.c. 

Mayonnaise 2  tablespoonfuls.  . .  42  gm 187       " 

Cut  the  cold  chicken  into  small  dice  and  cut  the  cleaned  celery  into 
small  uniform  pieces.  Mix  these  together  and  pour  over  the  oil.  Mix 
well,  then  sprinkle  with  salt  and  pepper  to  taste;  add  the  vinegar;  blend 
and  put  in  colander  to  drain ;  set  in  a  cold  place  for  two  or  three  hours. 
Just  before  serving  add  the  mayonnaise,  put  on  a  bed  of  lettuce  and 
garnish.  The  above  quantity  is  sufficient  for  six  servings.  Use  mayon- 
naise, olives,  celery  leaves  or  white  lettuce  for  garnishing. 

Note. — Do  not  mince  chicken.    - 

Broiled  Chicken  (Watson). — 

Small  chicken 1  pound 453  gm 890  calories 

Butter 1  ounce 30    "    240 

Pepper  and  salt }4  teaspoonf  ul  of  each 2    " 

Prepare  a  young  chicken  for  roasting,  split  it  down  the  back,  lay  it 
open,  and  take  only  half  at  a  time.  Rub  the  piece  of  chicken  over  with 
a  little  butter  to  keep  the  skin  from  cracking,  and  season  with  pepper  and 
salt.  Grease  the  gridiron  and  make  it  thoroughly  hot.  Lay  the  chicken 
on  it  with  the  cut  side  down.    Broil  either  on  the  top  of  or  before  a  clear 


POULTRY  629 

fire  for  about  half  an  hour.  When  cooked,  lift  on  to  a  very  hot  plate  and 
rub  the  rest  of  the  butter  over  it.  Ser\'e  with  rolls  of  bacon  round  it.  If 
broiling  an  older  fowl  it  must  be  partially  cooked  first,  either  by  boiling  or 
roasting.    It  may  be  eaten  with  or  without  bread  sauce. 

Stewed  Partridge  (Watson). — 

Partridge 3^  pound 225  gm 465  calories 

Butter y^  ounce 15    "    120 

Flour 1  teaspoonful 45    «    150       « 

Mace 1  blade 0.5" 

Lemon \^  with  rind 

Pepper  and  salt 3^  saltspoonf ul 

Cut  the  partridge  into  joints  and  take  out  the  largest  bones.  Put  the 
butter  into  a  small  stewpan.  When  it  gets  hot  put  in  the  best  parts  of  the 
partridge  and  dry  very  carefully.  Add  to  this  a  small  bit  of  lemon 
peel,  mace,  pepper  and  salt,  then  add  the  flour  and  1  teacupful  of  water, 
and  the  bones  that  were  removed.  Wlien  this  boils  up  put  on  the  lid,  and 
let  it  stew  slowly  for  three-quarters  of  an  hour,  or  until  tender.  Take  up 
the  best  bits  on  a  dish  and  strain  the  gravy  over  them.  All  game  is  easily 
digested  when  cooked  in  this  way. 

Roast  Poultry  (Wegele). — It  is  best  to  buy  fresh-killed  poultry.  Clean, 
remove  feathers  and  hang  in  a  cool  place  for  at  least  one  day;  in  the 
winter  for  2  to  3  days.  The  roasted  skin  of  poultry  should  never  be 
served  to  those  having  stomach  trouble,  as  it  is  very  indigestible.  A 
poiiiul  will  contain  about  800  calories. 

Capons  (Wegele). — Capons  and  pullets  should  be  roasted  with  very 
little  butter,  as  they  contain  a  great  deal  of  fat.  Baste  constantly  and 
roast  about  one  and  one-half  to  two  hours.     A  pound  capon  will  yield 

about  1.405  calories. 

Boiled  Broilers  and  Squabs  (Wegele). — Prepare  the  same  as  for  roast- 
ing. Piit  into  slightly  salted,  boiling  bouillon  with  a  handful  of  dry 
vegetables,  and  boil  about  one  to  one  and  a  quarter  hours.  Very  young 
pigeons  or  squabs  will  be  done  in  three-quarters  of  an  hour;  also  verv 
young  chickens  or  broilers.  A  pound  broiler  or  squab  yields  about  1,430 
calories. 

Stewed  or  Potted  Broilers  and  Squabs  (Wegele). — Prepare  broilers  or 
squabs  as  for  roasting.  Cut  into  four  equal  parts,  add  a  little  salt,  and 
stew  exactly  like  stewed  veal  for  about  three-quarters  of  an  hour.  Sauce 
to  be  prepared  the  same  as  for  stewed  veal.  IMedium  size  average  a  pound. 
Caloric  value  about  1,290  calories. 

140 


630    PREPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

MEATS 

General  Rules  for  Preparing  Meat — Meat  must  be  weighed,  trimmed, 
and  wiped  with  a  damp  cloth.  It  should  be  removed  immediately  from 
the  paper  in  which  it  has  been  wrapped  and  placed  in  a  cool  place.  Only 
tender  cuts  of  meat  should  be  broiled,  pan-broiled  or  roasted.  When  meat 
is  to  be  cooked  by  any  of  these  methods,  it  should  first  be  seared,  and  then 
the  temperature  slightly  lowered.  By  searing,  the  albumin  on  the  outer 
surface  of  the  meat  is  hardened,  and  the  meat  is  thus  cooked  in  its  own 
juices. 

Tough  meat  should  be  cooked  in  water.  Boiling  water  hardens  the 
albumin  on  the  outer  surface  of  the  meat  and  prevents  the  juices  from 
escaping.  Meat  should  be  put  in  boiling  water  and  the  water  allowed  to 
boil  for  ten  or  fifteen  minutes,  then  the  cooking  should  be  allowed  to  pro- 
ceed at  a  low  temperature  until  the  meat  is  tender.  If  the  water  bubbles 
it  is  too  hot.  Cooked  in  this  way  tough  meat  will  become  tender.  The 
time  required  for  roasting  or  cooking  in  water  varies  with  the  weight 
and  quality  of  the  meat  {see  Volume  II,  Chapter  III). 

Roast  meat  is  more  easily  digested  than  boiled  meat,  provided  the 
connective  tissue  has  been  made  more  soluble  by  hanging  the  meat  up  in 
the  refrigerator  for  a  few  days  before  cooking,  thereby  bringing  about  a 
post-mortem  lactic  acid  process.  Meat  rich  in  fat  is  acted  upon  with 
greater  difficulty  by  the  gastric  juice  than  lean  meat.  For  instance,  calf's 
brain,  although  very  soft,  contains  much  fat  and  is  not  well  tolerated  by 
the  invalid  or  convalescent.  Venison,  hare  and  deer  meat  have  a  less  fat 
content  than  beef,  but  the  disadvantage  of  tougher  muscular  fiber:  Meat 
of  young  animals  is  more  tender  than  that  of  old  ones,  and  hence  prefer- 
al)le.  Mild  smoked  ham  is  very  nourishing,  and  if  there  is  no  danger  of 
trichinae  may  be  eaten  with  impunity  uncooked. 

Roasting. — Skewer  the  meat  into  shape.  Place  it  on  a  rack  in  a  meat 
pan,  in  the  bottom  of  which  pieces  of  fat  from  the  meat  have  been 
placed.  Put  in  a  hot  oven  on  the  grate  for  ten  minutes  to  sear  the  meat. 
If  desired,  it  may  be  seasoned  with  salt  and  pepper.  Then  remove  to  the 
floor  of  the  oven  and  baste  every  ten  minutes  until  it  is  done. 

Broiling. — Remove  extra  fat  from  the  meat  and  grease  the  broiler 
with  a  part  of  the  fat.  Broil  over  a  clear  fire ;  sear,  and  then  turn  every 
ten  seconds.  Chops  one  inch  thick  should  be  cooked  for  five  minutes.  A 
steak  two  inches  thick  should  be  cooked  for  ten  minutes.  Season  and 
serve  on  a  hot  platter. 


MEATS  631 

Pan-broiling  (Drexel  Institute). — Remove  all  the  fat  from  the  meat. 
Heat  a  frying-pan  very  hot,  but  use  no  fat.  Sear  the  meat  on  both  sides, 
and  then  cook  more  slowly  until  it  is  done.  Stand  chops  up  on  their 
edges  to  brown.  Keep  the  pan  free  from  fat.  The  time  required  for  pan- 
broiling  is  the  same  as  that  required  for  broiling. 

Beef  Pulp  (Caultey). — Scrape  a  piece  of  raw  lean  rump  or  sirloin 
steak  with  a  fork  or  meat  scraper  until  as  much  as  possible  of  the  muscu- 
lar tissue  has  been  obtained,  separated  from  the  tendinous  parts.  Pound 
it  in  a  mortar  to  a  pulp,  and  then  rub  it  through  a  fine  sieve.  Season  with 
pepper  and  salt.  It  may  be  taken  in  the  form  of  sandwiches,  or  rolled 
up  into  small  rissoles  and  lightly  gTilled  or  fried. 

Very  little  of  the  nutriment  of  the  meat  is  lost  in  this  process. 

Beef  Quenelles  (Watson). — 

Beefsteak 1  pound 453  gm 1,130  calories 

Breadcrumbs 4  tablespoonfuls 32    "   45       " 

Salt  and  pepper  to  taste. .  .  .^  teaspoonful  of  each.  . .     1    " 

Egg 1  (whole) 50    «    .  . , 80 

Stock 2  tablespoonfuls 30  c.c 20 

Pound  the  beefsteak,  breadcrumbs,  salt  and  pepper,  egg  and  stock  well 
in  a  mortar,  rub  through  sieve,  shape  with  tablespoons  and  poach  in 
shallow  pan  for  ten  minutes  in  boiling  water.  Pour  a  gravy  made  of 
thickened  beef  tea  round  the  quenelles  and  serve  with  sippets  of  toast. 
This  is  a  very  digestible  dish,  nutritious  and  readily  absorbed. 

Roast  Veal  (Wegele). — 

Loin  of  veal 6  pounds 3,000  gm.. 4,540  calories 

Fresh  pork 1  pound 450    «  2,780 

Hot  butter  or  hot  beef  fat . .  a  little  less  than  }4  pound    200    "  1,590 

In  summer  veal  must  soak  in  sweet  milk  for  one  or  two  days,  in  winter 
about  2  to  4  days,  to  make  it  soft  and  tender.  Before  preparing  the  meat 
it  must  be  thoroughly  washed,  the  skin  removed  and  the  meat  well  salted. 
Lard  the  meat  with  fresh  pork  and  roast  in  hot  butter  or  hot  beef  fat, 
using  the  above  number  of  grams.  The  roasting  is  the  same  as  for  other 
meats,  but  it  must  be  well  done  and  will  take  one  and  one-quarter  to  two 
hours. 

If  the  bone  is  not  removed,  a  good  juice  will  come  forth,  and  after  the 
fat  has  been  removed  the  addition  of  a  little  bouillon  (no  flour)  will  give 
a  nice  sauce. 

Ordinary  serving — 100  grams,  174  calories. 


632  PEEPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

Roast  Venison  (Wegele). — Roast  in  hot  butter  and  baste  frequently; 
one  hour  required  for  roasting,  except  for  loin  of  venison,  which  is  not  so 
tender  and  will  take  two  and  one-half  hours  to  roast.  Sauce  to  be  pre- 
pared same  as  the  roast  fillet  sauce.  Sour  cream  can  be  added  to  the 
sauce. 

Ordinary  serving,  100  grams,  240  calories. 

Hamburger  Steak  (Wegele). — 

Beef K  pound 250  gm 660  calories 

Cold  salted  bouillon 4  tablespoonf  uls.  . .  120  c.c 13       " 

Take  a  nice  piece  of  beef,  chop  about  250  grams  (a  tumblerful),  and 
add  the  bouillon.  If  bouillon  is  not  available,  use  salted  water.  Fry  the 
meat  about  ten  minutes.     Chopped  veal  can  be  prepared  in  the  same  way. 

Stewed  Sweetbreads  (Wegele). — Cook  the  sweetbreads  until  very  soft, 
remove  skin,  cut  in  halves,  and  put  into  hot  butter  sauce  for  10  minutes 
before  serving.  The  sauce  is  prepared  in  this  way :  Take  a  piece  of  butter, 
put  it  into  a  saucepan  and  let  it  melt,  but  not  get  brown.  Add  one  table- 
spoonful  of  flour,  stir,  add  enough  cold  bouillon  and  a  little  white  wine  so 
that  after  boiling  there  will  be  a  thick  sauce.  The  sauce  will  be  easier  to 
digest  if,  instead  of  butter,  gravy  from  any  roast  meat  is  used,  but  the  fat 
must  be  taken  off  first.    Before  serving,  an  egg  can  be  added  to  the  sauce. 

Ordinary  serving — 80  to  100  grams,  135  to  150  calories, 

RAW    BEEF 

General  Method  of  Preparing  Raw  Beef — Raw  meat  forms  an  excellent 
aliment,  although  it  seldom  appears  on  our  tables  in  this  form.  Fick  has 
shown  that  raw  meat  is  digested  three  times  more  easily  and  quickly  than 
cooked  or  even  underdone  roast  meat.  Raw  meat  is  the  food  which  agrees 
best  with  very  delicate  stomachs,  with  tuberculous  individuals,  tabetics, 
chlorotics  and  even  with  many  children  who  are  obliged  to  be  weaned  pre- 
maturely, but  it  is  necessary  to  know  how  to  choose  and  to  use  it  method- 
ically. Great  care  should  be  exercised  in  the  selection  of  meat  to  be  in- 
gested in  its  raw  state.  The  flesh  of  pigs  should  be  avoided  altogether, 
as  it  is  too  firm,  and  may  transmit  various  parasites.  Meat  intended  to 
be  eaten  raw  should  be  freed  of  all  fat,  scraped  and  reduced  to  a  pulp 
with  the  edge  of  a  knife  or  a  spoon  handle,  but  not  chopped.  By  scrap- 
ing, the  muscle  fibers  are  separated  from  the  tendons  and  aponeurosis. 
This  scraping  results  in  little  balls  of  pulp  which  should  be  rolled  into 
boluses  about  the  size  of  a  nut  without  other  addition  than  a  little  salt  or 


MEATS  633 

perhaps  a  little  cognac,  rum,  sugar  or  the  gravy  of  meat  roast.    These  balls 
of  meat  pulp  ought  to  be  swallowed  by  the  individual  without  chewing. 

Raw  Meat  with  Milk  and  Sugar  (Ringer). — 

Rump  steak 3^  pound .250  gm 660  calories 

Sugar 2  lumps 12    «    50 

Brandy 4  teaspoonfuls 60  c.c 200       " 

Milk 3^  glass 250    "  170 

Scrape  the  steak  with  a  knife  until  all  the  pulp  is  removed,  sweeten 
with  sugar,  breaking  the  lumps  of  sugar  with  the  meat  in  a  basin  with  a 
small  wooden  spoon.  Add  slowly  as  much  milk  as  will  make  it  about  the 
thickness  of  arrowroot;  flavor  with  brandy.  If  any  fiber  of  the  meat  re- 
mains, strain  through  a  gravy  strainer.  The  mixture  should  be  perfectly 
smooth. 

Raw-meat  Juice  (Cheadle). — Add  to  finely  minced  rump  steak  cold 
W'ater  in  the  proportion  of  one  part  of  water  to  four  parts  of  meat.  Stir 
well  together,  and  allow  it  to  stand  for  half  an  hour.  Forcibly  express 
the  juice  through  muslin,  twisting  to  get  the  best  results. 

Raw  Beefsteak  (Wegele). — Take  a  good  piece  of  steak,  cut  a  square 
piece  the  thickness  of  a  thumb.  Pound  the  meat  well,  salt  on  one  side 
only.  Put  into  frying  pan,  fry  in  fresh  butter  for  one  minute.  Turn 
and  baste  with  the  juice  of  the  meat  and  again  fry  only  one-half  minute. 
Sen'e  at  once  on  a  hot  plate;  100  grams  (3|  ounces)  furnish  about  130 
calories. 

Raw-beef  Soup  (Weir  Mitchell). — 

Raw  beef 1  pound 450  gm 1,200  calories 

Water 1  pint 500  c.c. 

Strong  hydrochloric  acid 5  drops 0.35  c.c. 

This  is  made  by  chopping  up  the  raw  beef  and  placing  it  in  a  bottle 
with  the  water  and  hydrochloric  acid.  This  mixture  is  allowed  to  stand 
on  the  ice  over  night,  and  in  the  moniing  the  bottle  is  placed  in  a  pan  of 
water  at  110°  F.,  and  kept  at  about  this  temperature  for  two  hours.  The 
soup  is  then  placed  in  a  stout  cloth  and  strained  until  the  mass  that  re- 
mains is  almost  dry.  The  filtrate  is  given  in  three  portions  daily.  If  the 
taste  of  the  raw  meat  is  objectionable,  the  meat  may  be  roasted  quickly  on 
one  side  and  the  process  completed  in  the  manner  previously  described. 

Succus  Camis  (Meat  Juice)  (Pettenkoffer  and  Voit). — Cut  up  the 
meat  into  small  bits,  arrange  in  layers  separated  from  one  another  by 
coarse  linen,  and  then  place  in  a  powerful  press.    From  each  kilogram  of 


634    PREPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

meat  about  230  grains  of  a  blood-red  juice  are  obtained.  This  contains 
about  6  per  cent  of  albuminates.  Its  taste  is  similar  to  that  of  raw  meat ; 
its  flavor  may  be  improved  by  the  addition  of  salt  and  beef  tea  not  hot 
enough  to  coagulate  the  albumin. 

VEGETABLES 

General  Rules  for  Cooking  Vegetables — Wash  thoroughly ;  pare  or  scrape 
if  skins  must  be  removed.  Stand  in  cold  water  until  cooked  to  keep  them 
crisp  and  prevent  their  being  discolored.  Cook  in  boiling  water;  the 
water  must  be  kept  at  the  boiling  point.  Use  two  teaspoonfuls  of  salt 
with  two  quarts  of  water ;  put  the  salt  into  the  water  when  the  vegetables 
are  partially  cooked.  The  water  in  which  vegetables  are  cooked  is  called 
vegetable  stock. 

Fresh  green  vegetables  require  less  water  than  others.  Cabbage,  cauli- 
flower, onions  and  turnips  should  be  cooked  uncovered  in  a  large  amount 
of  water. 

All. vegetables  must  be  drained  as  soon  as  tender.  Season  with  salt 
and  pepper  and  serve  hot  with  butter  or  sauce.  The  color  may  be  kept  in 
green  vegetables,  such  as  spinach,  by  pouring  cold  water  through  them 
after  draining. 

Vegetables,  according  to  analysis,  are  known  to  possess  various  min- 
eral matters  and  the  green  vegetables  more  especially  contain  iron.  For 
analysis  and  the  mineral  content  of  vegetables  the  reader  is  referred  to 
the  section  of  the  book  dealing  with  this  subject  (Volume  I,  Chap- 
ter XIX). 

Cold  vegetables  may  be  used  for  salads  or  may  be  placed  in  a  baking 
dish  with  one-half  the  quantity  of  sauce  (2  cupfuls  vegetables  and  1  cup- 
ful sauce),  covered  with  buttered  crumbs  and  bro^vned  in  a  hot  oven. 

TIME-TABLE  FOR  COOKING  VEGETABLES  IN  WATER 
(Drexel  Institute) 

Potatoes 25-30  min.  Spinach 30-45  min. 

Carrots 35-45     «  Celery 20-30     " 

Turnips 45     "  Parsnips 30-45     " 

Beets  (young) '.       45     "  Green  peas 30-40     " 

"      (old) 3-4    hrs.  String-beans 1-3    hrs. 

Tomatoes 1-3       "  Lima  beans 1  hr.  or  more 

Onions 45-60  min.  Green  corn 12-20  min. 

Cabbage 45-60     "  Rice 20-45     " 

Cauliflower 20-30     «  Macaroni 45-60     « 

Asparagus 20-30     " 


VEGETABLES  635 

Sauce  for  Vegetables — 

Butter 3  tablespoonfuls.  . .  45  gm 360  calories 

Flour 3  «  ...  45    "   150       « 

Salt 1  teaspoonful 4    " 

White  pepper a  pinch 0.5  " 

Milk 1  cupful 250  c.c 170       " 

Stock 1      "     250    «  36       « 

Asparagus  (Wegele). — 

Asparagus 1  pound 453  gm 52  calories 

Salted  water 1  pint 500  c.c. 

Butter  sauce 8  tablespoonfuls.  . .  120    "  240       « 

Egg 1  yolk 18  gm 68 

Clean  asparagus,  remove  skin,  cut  off  the  hard  parts.  Boil  in  the 
salted  water  for  about  one-half  to  one  hour.  Use  enough  water,  otherwise 
the  asparagus  will  lose  its  color.  Serve  with  a  butter  sauce,  adding  the 
yolk  of  the  egg.  For  sensitive  stomach  use  only  asparagus  tips.  One 
hundred  grams  (a  little  less  than  1^  ounces)  furnish  about  20  calories. 

Spinach  (Wegele). — 

Spinach 1  pound 453  gm 110  calories 

Butter a  lump 15    "   120       " 

Flour  and  bouillon a  tablespoonful ...         47       " 

Clean  and  wash  spinach  thoroughly,  remove  the  stems  and  rinse  in 
water  several  times.  Put  the  spinach  into  boiling  water  and  boil  quickly. 
When  soft,  pour  into  a  sieve  and  allow  it  to  drain,  then  mash  through  the 
sieve.  Put  the  butter  into  a  saucepan.  When  dissolved,  add  the  flour 
and  bouillon,  making  a  thick  sauce.  Keep  it  on  the  fire,  stirring  con- 
stantly.   Add  the  spinach  and  boil  all  for  about  one-quarter  hour. 

Oyster  Plant  (Wegele).— 

Oyster  plant 1  pound 453  gm 100  calories 

Flour 1  teaspoonful 4    "  5       " 

Water 1  pound  (2  pints) .  .  1,000  c.c. 

Vinegar 1  tablespoonful. ...      15    " 

Butter,  salt  and  bouillon . ' 2  tablespoonfuls.  . .      30    " 140       " 

Clean  and  wash  the  oyster  plant  thoroughly,  cut  into  pieces  the  length 
of  a  finger.  To  the  flour  add  the  water  and  vinegar,  stir  until  smooth  and 
add  the  oyster  plant.  Put  all  into  a  colander,  pour  cold  water  over  it  and 
let  drain.  Put  into  a  cooking  vessel  containing  some  butter,  cover  tight, 
add  a  little  salt  and  a  little  bouillon  from  time  to  time  while  cooking.  It 
takes  three-quarters  to  one  and  a  half  hours  to  cook  oyster  plant  until  soft. 
Olio  liundred  grams  (a  little  more  than  1^  oz.)  furnish  about  120  calories. 


636  PKEPARATION  OF  SPECIAL  BEVERAGES  AND  EOODS 

Green  Peas  (Wegele). — It  is  best  to  use  canned  peas  of  the  very  best 
quality.  Empty  the  peas  into  a  sieve,  pour  cold  water  over  them  and 
strain.  Prepare  with  a  little  butter  and  salt  and  let  them  boil  for  about 
one-quarter  hour,  adding  strong  bouillon  and  a  little  sifted  flour.  The 
peas  can  also  be  mashed  through  a  sieve.  Split  peas  can  also  be  used  for 
this  purpose.  Puree  of  peas  is  considered  best  for  those  having  stomach 
trouble.  Let  the  dry  split  peas  boil  for  about  one-half  hour.  Two  hun- 
dred and  eighty  grams  furnish  about  1,000  calories. 

Carrots  (Wegele). — Only  small  carrots  should  be  used.  Clean  and 
wash  them  and  cut  them  into  lengthwise  pieces;  prepare  like  peas  or 
oyster  plant.  The  carrots  can  be  served  mashed.  After  they  have  been 
boiled,  mash  them  through  a  hair  sieve,  dust  with  a  little  flour  and  boil 
until  they  become  a  thick  mass.  One  hundred  grams  (a  little  less  than 
^  pound)  furnish  about  120  calories. 

String  Beans  (Wegele). — Young  string  beans  are  the  best  to  use. 
Clean  and  wash  them,  break  into  inch  lengths,  and  prepare  like  peas  in 
butter  and  beef  soup.  If  fresh  beans  are  not  in  season,  canned  string 
beans  can  be  used.  One  hundred  grams  {^  pound)  furnish  about  40 
calories. 

Cauliflower  (Wegele). — Clean  and  wash  the  cauliflower  and  cook  like 
asparagus.  Time  required,  about  4  hour.  For  those  with  stomach 
trouble  use  only  the  upper  part,  not  the  stems.  One  hundred  grams  (less 
than  ^  pound)  furnish  about  60  calories. 

Mashed  Potatoes  (Wegele). — 

Potatoes 1  pound 453  gm 385  calories 

Butter  (fresh) H  ounce 20    «   150 

Salt a  little 1    « 

Hot  milk 2}4  ounces 90  c.c 52       « 

Peel  and  wash  the  potatoes,  cut  into  4  parts,  boil  in  a  double  boiler 
until  soft.  Put  into  a  hair  sieve,  mash  thoroughly,  add  the  butter,  salt 
and  hot  milk,  put  back  on  the  fire  and  stir  constantly  until  smooth  and 
thick.  Serve  at  once.  Clear  beef  soup  may  be  added  instead  of  butter  if 
so  desired.     One  hundred  grams  (3|  ounces)  furnish  about  125  calories. 

Cauliflower  a  I'lndienne  (Watson). — 

Cauliflower 1  pound 453  gm 140  calories 

White  sauce }4  pint 250  c.c 256 

Grated  cheese 2  tablespoonfuls.  . .  20  gm 150       " 

Cocoanut 1  tablespoonf ul . ...  32    «    200 

Curry  powder 1-  dessertspoonful. . 


VEGETABLES  637 

Boil  cauliflower  tys^enty  to  thirty  minutes  until  the  stalk  part  is  tender. 
Drain  and  place  on  a  fireproof  dish.  Add  the  curry  powder  and  the  white 
sauce,  cooling  the  cauliflower  well.  Sprinkle  the  cheese  and  cocoanut  on 
top,  and  brown  quickly  in  a  good  oven.  Cauliflower  au  gratin  can  be 
made  by  increasing  the  amount  of  cheese  and  omitting  the  curry  powder 
and  cocoanut. 

Tomato  Savory  (Watson). — 

Tomatoes 6  small 600  gm 138  calories 

Tomato  sauce 1  gill 125  c.c 60       " 

Curry  powder 1  teaspoonful 

Red-currant  jelly 1  "  8  gm 28 

Breadcrumbs 2  tablespoonfuls 30    "    . 60  '     " 

Grated  cheese 2  "  28    "   200       « 

Butter }4  ounce 15    «   120 

Pepper  and  salt 34  teaspoonful  of  each.  . .     1    " 

Choose  small  firm  tomatoes.  Put  into  boiling  water  for  a  minute  or 
two,  lift  them  out,  dry  and  peel  them.  Then  grease  a  fireproof  dish  and 
place  the  tomatoes  in  it.  Sprinkle  them  with  half  the  crumbs  and  cheese, 
and  a  little  pepper  and  salt.  Add  the  curry  powder  and  the  red  currant 
jelly  to  the  tomato  sauce,  and  pour  this  over  the  tomatoes.  Put  the  re- 
mainder of  crumbs  and  cheese  on  the  top,  then  the  butter  in  small  pieces 
and  bake  in  a  moderate  oven  about  twenty  minutes.     Serve  hot. 

Mayonnaise  Dressii^  (Pattee). — 

Mustard 1  teaspoonful 4  gm 100  calories 

Powdered  sugar 2  teaspoonfuls 24    " 

Salt 1  teaspoonful  (level) .  . .     4    " 

Speck  cayenne. 

Eggs 2  yoiks. . .  .'. 36    "   136       « 

Nicelle  olive  oil VA  cups 316    "   2,900 

Vinegar 2  tablespoons 30  c.c. 

Lemon  juice 2  "  30    « 

(Individual  Rule,  ^  of  a  recipe.) 

Mix  dry  ingredients,  add  to  yolks  and  mix  thoroughly.  Add  a  few 
drops  of  oil  at  a  time  until  one-half  cup  is  used,  beating  with  egg  beater 
or  wooden  spoon.  Then  add  alternately  a  few  drops  of  vinegar  and 
lemon  juice  and  the  remainder  of  the  oil,  using  care  not  to  lose  the  stiff 
consistency.  It  should  be  a  thick  dressing  and  should  not  be  added  to 
food  until  just  before  serving.  A  tablespoonful  represents  about  190 
calories. 

Nofr. — Have  all  ingredients  and  utensils  thoroughly  chilled  and  place 
mixing  bowl  in  a  pan  of  crushed  ice  while  blending. 


638    PEEPARATION  OF  SPECIAL  BEVEEAGES  AND  FOODS 

Cream  Dressing  (Pattee). — 

Butter 14:  pound  (^  cup) . .  116  gra 900  calories 

Flour : 2  tablespoonfuls.  . .  30    «    30 

Scalded  milk 1  cupful 250  c.c 170       " 

Eggs 3  yolks 54  gm 204       « 

Eggs 3  whites 96    "    54       « 

Mustard 1  teaspoonf ul 4    " 

Cider  vinegar 1  tablespoonf ul. ...   15  c.c. 

Salt 1  teaspoonful 4  gm. 

Vinegar J^  cupful 120  c.c. 

Sugar y2      "     116  gm 465       « 

(a)  Melt  butter  in  a  saucepan,  add  flour  and  pour  on  gradually  the 
scalding  milk,  cook  thoroughly,  stirring  constantly,  {h)  Beat  yolks  in  top 
of  double  boiler,  add  the  mustard  (dissolved  in  one  tablespoon  of  vinegar), 
salt  and  vinegar.  Pour  {a)  gradually  on  the  egg  mixture  and  cook  over 
hot  water  until  it  thickens  like  soft  custard,  remove  from  fire,  add  the 
sugar,  and  fold  in  the  stiffly-beaten  white  of  eggs.  Pour  into  glass  fruit 
jar,  cool  and  cover,  and  keep  on  ice.  This  dressing  will  keep  a  long  time 
and  is  especially  delicious  to  serve  with  fruit  salads. 

PUREES 

Chicken  Puree  (Watson). — 

Roast  chicken  (whole) 4  pounds 2,000  gm 3,500  calories 

Onion,  carrot 1  pound 453    "  217       " 

Celery 2  leaves . 

Cream 3^  gUl 125  c.c 227       « 

Lemon  juice .a  few  drops 20    " 

Sugar small  liunp 10  gm 41       ** 

Remove  all  the  skin  and  bones  from  a  roast  chicken.  Chop  the  meat 
and  pound  it  in  a  mortar,  and  rub  through  a  sieve.  Take  the  bones  of 
the  chicken,  boil  for  several  hours  with  onion,  carrot,  celery  and  enough 
water  to  cover  them.  Strain  through  a  sieve,  and  remove  all  the  fat.  Add 
the  pounded  meat  and  simmer  until  it  is  sufiiciently  thick.  Add  the 
cream,  lemon  juice  and  sugar. 

Lettuce  Puree  (Wegele). — 

Salad  (Romaine  preferred). .  1  pound  (2 or 3  heads).  .  . 453  gm 60  calories 

Butter a  piece 15    «   120       " 

Flour a  Uttle 15    «   15 

Beef  soup V^  cup 125  c.c 25 

Take  the  salad,  using  only  the  hearts.  Separate  the  leaves,  rinse  in 
cold  water,  scald  with  boiling  water,  and  let  boil  in  salted  water  until  soft. 


FRUITS  639 

Put  into  a  colander  and  let  drain,  then  mash  thoroughly.  Melt  the  butter, 
add  the  flour,  not  allowing  it  to  brown,  stir  well,  add  the  salad,  also  a  little 
beef  soup,  and  boil  all  for  a  few  minutes.  A  little  sweet  or  sour  cream 
may  be  added,  if  permitted. 

Endive  Puree  (Wegele). — 

Endive  salad J^  pound 225  gm 45  calories 

Butter a  piece 15    "   120 

Flour small  spoonful 15    "   15       " 

Salt a  little 1    " 

Clear  soup 3^  cup 125  c.c 25       " 

Use  the  tender  stalks  of  endive  salad,  scald  them  two  or  three  times 
with  boiling  water,  so  they  may  lose  their  bitter  taste.  Boil  quickly  in 
salted  water  until  soft.  Pour  off  the  water  and  put  cold  water  over  it, 
drain  again  and  squeeze  the  endive  thoroughly.  Chop  the  stalks  and  mash 
through  a  sieve.  Melt  the  butter,  add  the  flour,  and  allow  it  to  brown. 
To  this  add  the  mashed  endive,  salt,  and  soup,  and  stir  until  it  becomes 
a  thick  mass. 

Bed  Cabbage  Puree  (Wegele). — Slice  the  cabbage  on  a  slicing  machine. 
Stew  in  butter  and  beef  soup  about  1  to  2  hours,  until  soft.  Mash  thor- 
oughly and  stew  again,  adding  a  little  wine  and  a  lump  of  sugar ;  also  a 
pinch  of  flour. 

FRUITS 

Baked  Apples  (Pattee). — ^Wipe  and  core  apples.  Put  in  a  shallow 
dish  with  one  tablespoon  water  to  each  apple.  More  may  be  added  during 
cooking  if  necessary.  Put  into  the  center  of  each  apple  two-  teaspoons 
of  sugar.  Bake  in  a  hot  oven  twenty  to  thirty  minutes,  or  until  soft; 
baste  with  the  sirup  every  ten  minutes.  A  little  nutmeg  may  be  added  to 
the  sugar,  and  a  few  drops  of  lemon  juice  to  each  apple.  Care  must  be 
taken  that  apples  do  not  lose  their  shape  and  break.  One  medium  apple, 
150  grams,  furnish  YO  calories. 

Apricot  and  Prune  Sauce  (Pattee). — 

Prunes 5  large  (^  cup) .  . .  100  gm 265  calories 

Dried  apricots }4  cup 40    "   114       " 

Cold  water 1  cup 

Sugar  to  taste 

Wash  fruit  carefully,  soak  over  night,  and  cook  slowly  for  two  hours. 
Tf  cooked  properly  the  fruit  will  need  very  little  sugar,  as  the  sugar  in 
the  fruit  is  developed  by  this  method  of  cooking. 


640    PREPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

Orange  (Pattee). — Select  a  large,  firm  orange,  wash,  cut  and  peel 
skin  down  in  eight  parts,  leaving  them  connected  to  stem  end  of  orange 
to  form  petals,  and  folding  them  nnder  the  pulp.  Separate  pnlp  in  sec- 
tions and  pnt  ice  between  petals  before  serving.  One  medinm  orange, 
250  grams,  furnishes  96  calories. 

Pineapple  (Pattee). — 

Hawaiian  pineapple 2  slices 100  gm 44  calories 

Cherry 2  Maraschino 

Serve  pineapple  on  small  tea  plate  with  cherry  in  center.  To  eat  a 
slice  of  pineapple  after  a  meal  is  quite  in  accordance  with  physiological 
indications,  as  pineapple  juice  contains  a  remarkable  digestive  principle 
similar  to  pepsin.  It  aids  the  work  of  digestion  in  the  stomach,  also  in 
the  intestinal  tract.  The  Hawaiian  pineapple  comes  in  three  forms — 
sliced,  crushed  and  grated.  The  sliced  pineapple  is  usually  served  just 
as  it  comes  from  the  can.  The  crushed  and  grated  are  used  like  apple 
sauce  and  also  in  delicious  made  desserts  and  beverages. 

Stewed  Prunes  (Pattee). — ^Wash  and  look  over  the  prunes,  cover  with 
clear  cold  water,  and  allow  them  to  stand  on  the  back  of  the  range  over 
night.  In  the  morning  put  the  saucepan  where  they  will  cook  slowly  for 
four  hours. 

Note. — No  sugar  is  needed  as  prunes  are  18  per  cent  sugar,  and  by 
this  manner  of  cooking  are  made  very  sweet.  This  simmering  process 
renders  them  rich  and  juicy,  while  boiling  toughens  the  skin.  A  little 
lemon  juice  is  a  pleasant  addition.  Prunes  are  a  valuable  nutrient,  and 
their  use  as  a  laxative  is  scarcely  second  to  figs.  Three  prunes,  60  grams, 
furnish  125  calories. 

Stewed  Figs  (Pattee). — 

Figs 14.  pound 275  gm 737  calories 

White  sugar K  cup 30    «    120 

Cold  water 1    "   250  c.c. 

Juice  of  lemon }/2 15   " 

Wash  figs.  Dissolve  sugar  in  water,  add  figs  and  bring  slowly  to  boil- 
ing point.     Stew  two  and  one-half  hours.    When  tender,  add  lemon  juice. 

Note. — Cut  figs  in  small  pieces,  cook  very  slowly  so  as  not  to  add  more 
water. 


NUTS  641 


NUTS 


Cooking  of  Nuts  (Pattee). — Nuts  are  more  often  eaten  raw  than 
cooked,  l>ut  the  peanut  is  not  considered  palatable  when  raw,  and  the 
chestnut  is  indigestible  unless  the  starch  is  cooked,  when  it  becomes  very 
easily  digestible.  Almonds  arc  widely  used  in  confectionery.  Nuts  may 
be  used  as  staple  articles  of  diet,  in  salad,  soups,  desserts,  etc. 

To  insure  the  best  utilization  of  nuts  they  must  be  thoroughly  pre^ 
pared  for  digestion  by  grinding  or  mastication.  Nut  butters  offer  much 
less  resistance  to  digestion  than  raw  nuts  hastily  eaten.  On  account  of 
the  high  fat  content,  these  products  must  be  fresh,  or  the  fat  is  likely  to 
decompose  (become  rancid)  and  be  irritating. 

Digestibility — Nuts  have  been  considered  very  indigestible.  This  is 
due  largely  to  improper  mastication  or  other  preparation  for  digestion; 
to  the  fact  that  they  are  a  very  concentrated  food,  and  are  often  eaten 
when  not  needed.  While  nut  protein,  as  imts  are  ordinarily  eaten,  is  not 
so  easily  nor  completely  digested  as  meat  protein,  there  are  experiments 
showing  that,  on  the  whole,  they  are  as  thoroughly  digested  as  an  ordinary 
mixed  diet.  No  experiments  have  been  reported  on  the  ease  or  rapidity  of 
nut  digestion. 

Nutritive  Value. — Nuts  are  a  concentrated  food.  This  is  clearly  shown 
by  the  following  figures : 

1  pound  of  Almonds  yield 2,895  calories 

1      «       "  Brazil  nuts  yield 3,120 

1       "       "  Filberts  yield 3,100 

1       "       «  Hickory  nuts  yield 3,345       " 

1       «       «  Peanuts  yield 2,610 

1       "       «  Walnuts  yield 3,075 

The  high  fuel  value  is  due  to  the  absence  of  water  and  the  large 
amount  of  fat  present.  Nuts  can  be  most  advantageously  used  along  with 
bulky  foods,  such  as  fruits  and  vegetables,  and  those  lacking  in  fat,  such 
as  bread.     In  a  vegetarian  diet  they  become  a  valuable  source  of  protein. 

Chestnut  Puree  (Wegele). — 

Chestnuts 1  pound 553  gm 1,125  calories 

Butter 3  ounces 90    «   675 

Salt a  little 1    « 

Sugar a  little 10    "    41        « 

The  chestnuts  are  peeled  and  boiled  in  water  until  the  second  (inside) 
skin  comes  off'  easily.     They  are  then  placed  in  a  sieve  until  all  the  water 


642  pkeparatio:n^  of  special  beverages  and  foods 

drains  off,  washed,  and  afterward  pressed  through  a  sieve.  Melt  the  but- 
ter in  a  stewpan  on  the  fire,  add  the  salt  and  sugar — enough  to  cover  the 
point  of  a  knife — and  then  the  chestnuts.  Stew  them  for  half  an  hour, 
stirring  frequently;  pour  in  enough  bouillon  so  tiiat  the  mush  does  not 
get  too  thick. 


JELLIES 

Gelatinous  articles  of  nutrition  are  made  from  cartilage,  tendons,  con- 
nective tissue  and  bone.  The  gelatin  is  rapidly  and  completely  decom- 
posed in  the  alimentary  canal  and  quickly  reaches  the  tissues  and  serves 
as  a  preserver  of  protein  and  fats.  Gelatinous  food  aids  the  coagulability 
of  the  blood  and  when  taken  in  excess  may  cause  diarrhea. 

Chicken  Jelly  (Adams). — Clean  a  fowl  that  is  about  a  year  old,  remove 
skin  and  fat,  chop  bones  and  flesh  fine,  place  in  a  pan  with  two  quarts  of 
water ;  heat  slowly ;  skim  thoroughly ;  simmer  five  or  six  hours ;  add  salt, 
mace  or  parsley  to  taste;  strain,  and  cool.  When  cool,  skim  off  the  fat. 
The  jelly  is  usually  relished  cold,  but  may  be  heated.  Data  for  estimat- 
ing the  caloric  value  of  this  preparation  are  not  available. 

Veal-bone  Jelly 

Veal  bones 10  pounds 5,000  gm 1,615  calories 

Water 10  quarts 10,000  c.c. 

Barley 2  pounds 1,000  gm 3,300       " 

Salt a  little 3    " 

Eggs yolks 72    «   272       « 

Place  the  veal  bones  and  water  or  weak  bouillon  over  the  fire  and  just 
bring  to  a  boil.  Skim  and  add  the  barley  and  a  little  salt.  Simmer  for 
five  or  six  hours  and  then  strain.  If  too  thick,  dilute,  before  serving,  with 
bouillon.  Stir  in  the  yolk  of  an  egg  for  each  cup  and  serve.  Each  cup 
will  represent  in  full  value  about  100  calories. 

Meat  Jelly  (Hepp). — This  is  made  by  cooking  good  boneless,  lean 
beef  on  a  water  bath  with  a  little  water  for  sixteen  hours  or  until  it  be- 
comes gelatinized.  Of  the  artificial  preparations  on  the  market  for  mak- 
ing bouillon,  the  most  reliable  is  Liebig's  Extract  of  Meat  (10 :250 
grams),  or  Cibil's  Bouillon  (1  teaspoonful  to  250  grama).  Tnaglio's 
bouillon  capsules  are  also  very  convenient.  If  it  is  desired  to  make  the 
bouillon  more  nutritious,  one  teaspoonful  of  meat  peptone  may  be 
added. 


JELLIES  643 

Jelly  for  Dyspeptics  (Weil). — 

Calf's  foot 1  pound 553  gm 250  calories 

Beef,  or ^  kilo 275    "  800 

Hen  (old) K  fowl 1,000    «  1,800       « 

Water ^  liter. 250  c.c. 

Salt 1  hp.  teaspoonful. .  5  gm. 

Egg 1  (whole) 50    "  80       « 

Cornstarch a  little 30    "  100       " 

Extract  of  meat 1  tablespoonful. ...        5    "  20      " 

Remove  the  skin  and  meat  from  the  calf's  foot;  wash  the  bones  and 
place  in  cold  water  on  the  stove;  when  it  begins  to  foam,  skim  off  the 
refuse  which  gathers  on  top.  After  rinsing  off  the  scum  with  cold  water, 
put  the  bones  into  a  pot  with  the  beef  or  hen,  water  and  salt,  and  boil 
slowly  for  from  four  to  five  hours.  Pour  the  jelly  thus  formed  through 
a  fine  sieve,  and  place  overnight  in  a  cellar.  Next  morning  remove  the 
fat,  and  clarify  the  cold  jelly  by  adding  the  beaten  egg  with  its  shell 
mashed,  and  stirring  steadily.  Then,  with  the  addition  of  a  little  corn- 
starch, subject  the  whole  to  a  temperature  not  over  168°  F.,  or  the  white 
of  the  egg  will  curdle.  Constantly  beat  and  stir.  If  the  jelly  begins  to 
get  grainy,  cover  and  let  it  cool  until  the  white  of  the  egg  becomes  flaky 
and  separates.  Then  strain  again  several  times  until  it  becomes  perfectly 
clear ;  add  the  extract  of  meat,  pour  the  jelly  into  a  mold,  and  let  it  cool 
again.  The  gravy  from  a  roast  may  be  utilized  and  is  very  palatable.  It 
must  be  stirred  in  while  the  mass  is  still  warm  and  liquid.  This  jelly  is 
usually  relished  with  cold  fowl,  but  spoils  easily  iii  summer;  it  must, 
therefore,  be  kept  on  ice.     One  hundred  grams  contain  about  20  calories. 

Calf's  Foot  Jelly  (Sweet)   (Watson).— 

Ox  foot,  or 1  pound 553  gm 250  calories 

Calf's  feet 1  pound 553    «  .250       « 

Sugar }4  pound 276    "  930       « 

Eggs 4  (whole) 200    "  320       « 

Ivemons 4  (whole) 520    «  205       « 

Mace 1  blade 1    " 

Cinnamon  stick 1  inch 1    " 

Cloves 4  seeds 1    " 

Sherry  wine 2  glasses 60  c.c 76       " 

Water 2  quarts 2,000    « 

Two  calf's  feet  are  equal  to  one  ox  foot,  and  make  the  same  quantity 
of  jelly ;  they  are  prepared  in  the  same  way  as  the  ox  foot,  but  need  not 
be  boiled  quite  so  long.  Get  the  ox  foot  broken  across  several  times;  split 
it  up  between  the  toes ;  take  out  the  piece  of  fat  between  the  toes  and  all 


644    PKEPARATION  OF  SPECIAL  BEVERAGES  AIs^D  FOODS 

the  marrow  from  the  bones.  First  blanch  the  foot  by  thoroughly  washing, 
covering  with  cold  water  and  bringing  it  to  the  boil.  Now  place  it  in  a 
basin  of  cold  water,  and  scrape  well. 

After  again  rinsing  in  cold  water,  put  it  on  in  a  clean  pot  with  two 
quarts  of  cold  water,  bring  it  to  the  boil,  skimming  it  well,  and  boil  very 
gently  for  about  eight  hours.  If  very  gently  simmered  by  the  side  of  the 
fire,  the  stock  does  not  reduce  too  much.  Strain  it  into  a  basin,  either 
through  a  towel  or  a  sieve,  and  stand  aside  to  get  quite  cold.  There  should 
be  six  breakfastcupfuls  of  stock.  When  quite  cold,  remove  all  the  fat 
from  the  top ;  this  must  be  done  very  carefully.  Now  put  the  stock  into  a 
clean  saucepan,  add  the  sugar,  the  flavorings  broken  into  small  pieces,  the 
lemon  rind  very  thinly  pared  off,  the  juice  strained,  two  eggs  and  the 
whites  of  the  other  two  eggs  beaten  up,  and  a  little  crushed  eggshell.  Put 
this  on  the  fire  and  whisk  briskly  until  it  comes  to  boiling  point.  Allow 
it  to  boil  very  gently  about  seven  minutes.  Withdraw  from  the  fire,  cover 
it  with  the  lid,  and  allow  it  to  settle  for  five  or  ten  minutes. 

Have  a  flannel  or  felt  jelly-bag  hanging  iip.  Pour  a  good  deal  of  boil- 
ing water  through  the  bag  to  warm  and  cleanse  it.  When  the  water  has 
all  run  out,  put  a  clean  basin  under  the  bag  and  pour  the  jelly  twice 
through  the  bag,  when  the  jelly  should  be  clear  and  a  brilliant  color.  This 
jelly  is  excellent  without  wine.  If  wine  is  used,  it  is  best  put  into  the 
saucepan  just  before  the  jelly  is  poured  into  the  bag. 

Milk  Jelly  (Wegele).— 

Milk 2  liters  (4  pints) . .  .2,000  c.c 1,360  calories 

Sugar 1}4  cups 250  gm 1,000 

White  gelatin 1  ounce 30    " 100       " 

Water 1^  cups 250    " 

Good  white  wine 3  wineglassf uls ....    400    " 229       * 

Boil  the  milk  for  five  to  ten  minutes  with  the  sugar  and  let  cool.  Make 
a  solution  of  the  white  gelatin,  add  water  and  the  white  wine.  Stir  all 
slowly.  Add  to  above.  Pour  into  a  mold  and  let  cool.  One  hundred 
grams  (one-half  cup)  are  equivalent  to  250  calories. 

General  Directions  for  Dishes  Made  with  Gelatin. — Gelatin  should  be 
soaked  in  cold  water  for  about  half  an  hour  to  soften  it.  It  may  then  be 
easily  dissolved  by  adding  boiling  water.  If  it  is  desired  to  soften  gelatin 
quickly,  it  should  be  placed  in  cold  water  and  gradually  heated  over  boil- 
ing water  until  it  dissolves.  If  a  jelly  is  to  be  strained,  a  wet  cloth  should 
be  used  for  the  purpose.  Jelly  molds  should  be  wet  with  cold  water  before 
being  filled.  When  granulated  gelatin  is  used,  much  smaller  amounts  are 
required  than  when  the  ordinary  form  is  used. 


JELLIES  645 

Wine  Jelly  (Drexel  Institute). — 
Granulated  gelatin 1  teaspoonful 4  gm 25  calories 


30c.c 
125    " 

40  gm 160 

5  c.c 
30    "  50 


Cold  water 2  tablespoonf uls 

Hot  water 3^  cupful 

Sugar 2  tablespoonfuls 

Lemon  juice ^  teaspoonful.  . 

Wine 2  tablespoonfuls 

Soak  the  gelatin  in  the  cold  and  hot  water.  Add  the  sugar  and  lemon 
juice,  and  when  cooling  add  the  wine.  ^ 

Lemon  Jelly. — Lemon  jelly  is  made  in  the  same  manner  as  wine  jelly, 
just  described,  using  a  tablespoonful  of  lemon  juice  in  place  of  the  quan- 
tity directed. 

Orange  Jelly. — 

Lemon  juice 2  teaspoonfuls 15  c.c 

Orange  juice 4  tablespoonfuls.  . .  60    "    40  calories 

Sugar 3  "  .  . .  60  gm 240 

The  above  is  made  in  a  similar  manner  as  the  previous  recipe,  using 
the  lemon  juice,  orange  juice  and  sugar,  but  a  little  less  of  the  boiling 
water. 

Wine  Jelly  (Sweet  Wine  Jelly  from  Gelatin)  (Watson). — 

French  sheet  gelatin 1}4  ounces 37  gm 222  calories 

Cold  water 3  gills 360  c.c. 

Lemon  juice 3^  gill 60    " 

Sherry  wine }4    " 60    "   65       " 

Brandy 1  tablespoonful. ...   15    "  40       " 

Loaf  sugar 3  ounces 90  gm 360       " 

Lemon 1  rind 2    " 

Cloves 2  or  3 1     " 

Cinnamon  stick 1  inch 1     " 

Egg 1  white 32    "   18       « 

Put  all  the  ingredients  into  a  lined  saucepan ;  whisk  until  they  boil ; 
remove  to  the  side  of  fire  w'hen  the  scum  begins  to  rise  in  the  top.  Cover 
the  top  of  the  pan  with  a  plate,  and  allow  it  to  stand  fifteen  minutes. 
Strain  through  a  hot  jelly  cloth  three  or  four  times  till  clear;  when  cold, 
mold  in  a  scalded  wet  mold. 

Cream  Jelly  or  Blancmange  (Watson). — 

Milk 1  gill 60  c.c 45  calories 

Cream 1    " 60    «  120 

Isinglass J^  ounce 7  gm 42       " 

Lemon 1  rind 4    " 

Sugar 1  ounce 30    «    120 

141 


646  preparatio:n^  of  special  beverages  and  foods 

Rinse  out  a  small  saucepan  and  put  into  it  the  milk,  isinglass  and 
thinly  peeled  rind  of  half  a  lemon.  Let  this  stand  by  the  side  of  the  fire 
until  the  isinglass  is  dissolved  and  the  milk  well  flavored  with  the  lemon. 
Stir  occasionally  to  prevent  boiling.  Add  the  sugar,  and  strain  into  a 
basin  to  keep  back  the  lemon  rind.  Add  the  cream,  and  stir  occasionally 
until  nearly  cold.  If  not  stirred,  the  milk  and  cream  will  separate.  Pour 
into  a  small  basin  that  has  been  rinsed  out  with  cold  water,  and  place  in 
a  cool  position  to  set.  Turn  out  and  serve  with  a  little  red  or  black  cur- 
rant jelly. 

Nutritious  Coffee  Jelly  (Thomas). — 

Isinglass  or  gelatin a  little 2  gm 12  calories 

Freshly  ground  coffee 3^  ounce 15    " 

New  milk 1  pint 500  c.c 340 

Egg 1  (whole) 50  gm 80       « 

Dissolve  the  isinglass  or  gelatin  in  water,  put  the  coifee  into  a  sauce- 
pan with  the  new  milk,  which  should  be  nearly  boiling  before  the  coffee 
is  added ;  boil  together  for  three  minutes ;  clear  it  by  pouring  some  of  it 
into  a  cup  and  dashing  it  back  again ;  add  the  gelatin,  and  leave  it  to  set- 
tle in  a  warm  place  for  a  few  minutes.  Beat  up  the  egg  in  a  breakfast 
cup,  and  pour  the  coffee  upon  it ;  if  preferred,  drink  without  the  egg. 

Milk  Jelly  (Schlesinger). — 

Milk 2  quarts 2,000  c.c 1,360  calories 

Sugar }4  pound : .    275  gm 930 

Gelatin 1  ounce 30    «  108 

Cold  water 1  cupful 250  c.c. 

Juice  of  lemons 2  or  3 40    " 

Good  Bordeaux  wine 3  glasses 90    " 135       " 

To  the  milk  add  the  sugar.  Boil  for  five  or  ten  minutes.  Cool  and 
add  the  gelatin  dissolved  in  the  cold  water.  Flavor  with  the  juice  of  the 
lemons  and  wine. 

Irish-moss  Blancmange  (Drexel  Institute). — 

Irish  moss 1  tablespoonful. ...     8  gm 30  calories 

Milk K  cupful 175  c.c 85       « 

Salt a  httle 1  gm. 

Wash  the  moss  in  several  changes  of  water,  and  pick  it  over  carefully. 
Place  it  in  a  double  boiler,  together  with  the  milk.  Cook  until  it  thickens 
when  dropped  on  a  cold  plate.  Add  salt,  strain  and  flavor.  Pour  into 
a  custard  cup  that  has  first  been  rinsed  in  cold  water. 


CUSTARDS  647 

Meat  Jellies  with  Gelatin 

Meat  broth 1  pint 500  c.c 52  calories 

Granulated  gelatin 1  teaspoonful 4  gm ; 25       " 

Use  any  kind  of  meat  broth  desired,  but  always  one  with  appetizing 
flavor.  Add  the  gelatin  to  enough  broth  to  cover  it,  and  allow  the  gelatin 
to  soak  for  a  few  minutes.  Then  add  the  remainder  of  the  broth  very 
hot,  and  stir  until  the  gelatin  is  dissolved.  Strain  and  pour  into  molds 
to  cool. 

Meat  Jellies  with  Tapioca 

Broth 1  cupful 250  c.c 26  calories 

Powdered  tapioca 4  level  tablespoonf uls . .  60  gm 90       " 

Salt a  pinch 1    " 

Mix  the  broth  as  above  with  the  powdered  tapioca.  Heat  until  quite 
clear,  stirring  constantly.  Add  salt  and  season  as  desired.  Pour  into 
molds  and  cool. 

Meat  Jellies  with  Irish  Moss. — 

Irish  moss 2  tablespoonf  uls.  . .     8  gm 25  calories 

Hot  broth 1  cupful 250  c.c 26 

Wash  the  moss  thoroughly.  Add  this  to  the  hot  broth  and  allow  it  to 
stand  for  half  an  hour ;  then  heat  slowly,  stirring  constantly,  and  boil  for 
ten  minutes,  preferably  in  a  double  boiler.  Strain,  pour  into  molds,  and 
cool. 

CUSTARDS 

Rules  for  Custards  (Drexel  Institute). — The  eggs  should  bo  thoroughly 
mixed  but  not  beaten  light,  the  sugar  and  salt  added  to  these,  and  the  hot 
milk  added  slowly.  Custards  must  be  cooked  over  moderate  heat ;  if  a  cus- 
tard curdles,  put  it  in  a  pan  of  cold  water  and  beat  until  smooth.  Cus- 
tards should  always  be  strained. 

Soft  Custard. — 

Milk 1  pint 500  c.c 345  calorics 

Eggs 2  yolks 36  gm 130 

Sugar 2  tablespoonf  uls.  . .  30    «   120       " 

Salt a  pinch 1    " 

Vanilla 2  teaspoonfuls 4  c.c. 

Sherry 4  «  30    «  38 

Mix  the  yolks  of  eggs,  sugar  and  salt  in  a  bowl.  Heat  the  milk  to  the 
boiling  point  and  add  to  the  eggs,  sugar  and  salt,  stirring  constantly.  As 
soon  as  mixed,  pour  into  the  saucepan  in  which  the  milk  has  been  heated, 


648    PKEPAKATlOi^  OF  SPECIAL  BEVEKAGES  AND  FOODS 

and  cook  from  three  to  five  minutes,  stirring  constantly  until  it  thickens. 
Strain,  and  pour  into  a  cold  bowl,  and  flavor  with  vanilla,  sherry  or  other 
flavoring  material  as  desired.  Custards  may  be  cooked  to  advantage  in 
a  double  boiler. 

Savory  Custard  (Anderson). — Add  the  yolks  of  two  eggs  to  a  cupful 
of  beef  tea,  with  pepper  and  salt  to  taste.  Butter  a  cup  or  a  jam  pot; 
pour  the  mixture  into  it,  and  let  it  stand  in  a  pan  of  boiling  water  till  the 
custard  is  set. 

This  will  furnish  150  calories. 

Custard  Sauce  (Watson). — 

Eggs 2  yolks 36  gm 135  calories 

Egg 1  white 32    "   18 

Sugar 1  dessertspoonful . .     8    "   32       " 

Milk K  pint 250  c.c 170       « 

Flavoring a  few  drops 1    " 

Rinse  out  a  small  lined  saucepan  with  cold  water,  put  the  milk  into 
it,  and  let  it  heat  over  the  fire.  Put  the  yolks  and  white  of  egg  into  a 
basin  with  sugar,  and  mix  them  well  together  with  a  wooden  spoon.  Then 
pour  the  hot  milk  gi'adually  onto  them,  stirring  all  the  time  and  mixing 
thoroughly.  Return  all  to  the  saucepan,  and  stir  very  carefully  over  the 
fire  until  the  sauce  thickens.  On  no  account  must  it  be  allowed  to  boil, 
or  it  will  curdle.  Have  ready  at  hand  a  clean  basin  and  strainer.  As 
soon  as  the  sauce  shows  signs  of  thickening,  and  it  is  almost  boiling,  re- 
move the  pan  from  the  fire,  continue  stirring  for  a  few  moments,  and  then 
strain  into  a  basin.  Add  flavoring  to  taste — lemon,  vanilla,  nutmeg  or 
cinnamon.  This  can  be  made  richer  by  increasing  the  proportion  of  yolks 
to  white.  It  can  be  served  as  sauce,  or  in  a  custard  glass,  with  flavoring 
grated  on  the  top. 

Baked  or  Cup  Custard  (Individual  Rule)   (Pattee). — 

Milk 1  cup 250  c.c 170  calories 

Egg 1  (whole) 50  gm. 80 

Sugar 1 J^  tablespoons 6    "   24       " 

Salt H  saltspoon 1    " 

Flavoring  to  taste:  nutmeg,  cin- 
namon, vanilla,  or  lemon  ex- 
tract. 

Scald  the  milk :  boat  the  egg,  add  sugar  and  salt,  and  pour  onto  it 
gradually  the  scalded  milk.  Flavor  to  taste  and  pour  into  custard  cups; 
place  in  deep  pan  and  pour  boiling  water  around  until  it  almost  reaches 


CUSTARDS  649 

the  top  of  cups.  J  Jake  in  inoderate  oven  about  twenty  minutes.  If  cinna- 
mon is  used  for  flavor,  put  one-half  square  inch  into  the  milk  when  scald- 
ing. 

Note, — To  test,  dip  a  pointed  knife  into  water  and  plunge  into  the 
middle  of  the  custard.  If  it  looks  set  and  the  knife  comes  out  clear,  the 
custard  is  done;  if  milky,  it  is  not  cooked  enough.  If  cooked  too  long 
the  custard  will  curdle. 

Chocolate  Custard  {Individual  Rule)   (Fitch). — 

Walter  Baker's  chocolate 2  teaspoonfuls 15  gm 89  calories 

Milk 2  tablespoonfuls.  . .  30  c.c 42       " 

Rich  milk 6  "  ...  90    "  160       " 

Eggs 2  yolks 36  gm 130 

Sugar 2  teaspoonfuls 8    "    32       " 

Salt a  speck 1    " 

Grate  chocolate  and  mix  with  the  two  tablespoons  of  milk ;  stir  over 
the  fire  until  smooth,  add  the  rich  milk,  the  well-beaten  egg  yolks,  sugar 
and  salt.  Pour  into  custard  cups  set  in  pan  of  hot  water  (nearly  to  the 
top).    Cook  until  custard  is  set.     Serve  hot  or  cold. 

Custard  Souffle  {Individual  Rule)   (Pattee). — 

Butter 1  tablespoonful. ...   15  gm 120  calories 

Flour 1^  tablespoons 37    "    118 

Scalded  milk M  cup 60  c.c 40       " 

Egg 1  yolk 18  gm 65 

Sugar 1)4  tablespoons ....  20    "    80       " 

Egg 1  white 32    "   18 

]\[elt  butter,  add  flour,  and  then  gradually  the  scalding  milk.  Cook 
thoroughly,  pour  into  the  well-beaten  yolk,  add  sugar,  and  cool.  Fold  into 
mixture  the  well-beaten  whites.  Turn  into  buttered  custard  cups  and  bake 
about  fifteen  minutes,  until  firm — determined  by  pressing  with  the  finger. 
Take  from  oven  and  serve  at  once,  or  it  will  fall.    Serve  with  foamy  sauce. 

Peach  Meringue  {Individual  Rule)  (Pattee). — 

Yellow  peaches 1  cup 253  gm 58  calories 

Sugar  to  taste 2  tablespoonfuls.  . .  30    "    120 

Egg 1  yolk 18    "   65 

Bread  crumbs 1  tablespoonful. ...    15    "    15       " 

Egg 1  white 32    "    18 

Powdered  sugar 1  tablespoon 16    "   64       " 

Stew  peaches  in  a  very  little  water,  sweeten  to  taste,  and  stir  in  the 
well-beaten  yolk.  Butter  a  pudding  dish  and  cover  bottom  with  fine  bread 
crumbs;    put   in    the   peaches    and  bake    fifteen   minutes.      Cover   with 


650    PEEPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

meringue  made  of  white  of  egg  and  the  powdered  sugar;  brown  slightly 
in  the  oven.     Serve  cold. 

Cocoa  Junket 

Cocoa 1  teaspoonf ul 4  gm 50  calories 

Milk  sugar 1  ounce 30    "   120 

Milk 5  ounces 150  c.c 100       « 

Junket  tablet M 0-25  gm. 

Cold  water 1  ounce 30  c.c. 

Dissolve  the  junket  tablet  in  the  water.  Mix  the  cocoa  and  sugar, 
add  the  milk,  and  heat  lukewarm,  stirring  constantly;  add  the  dissolved 
junket  tablet,  stir  thoroughly,  and  leave  in  a  warm  place  to  set. 

Soft  Custard — 

Milk 1  cup  (8  ounces). .  .250  c.c 160  calories 

Egg 1  (whole) 50    «    80 

Milk  sugar 2  ounces 60  gm 240       " 

Salt a  speck. 

Vanilla 2  to  3  drops. 

Caramel,   made   of   granulated 

sugar 3  tablespoonfuls. . .  45    "   180       " 

Beat  the  egg  slightly ;  add  the  sugar,  salt  and  hot  milk  slowly.  Cook 
in  a  double  boiler,  stirring  constantly,  until  it  thickens  a  little  (if  cooked 
too  long  the  custard  will  curdle,  but  may  become  smooth  again  if  set  in  a 
dish  of  cold  water  and  beaten  at  once).     Flavor  and  cool. 

To  make  caramel :  Put  the  sugar  in  a  pan  directly  over  heat  and  burn 
until  a  very  dark  brown.     Dissolve  in  hot  water  or  milk. 

Plain  Junket  or  Rennet  Custard. — 

Milk  sugar 1  ounce 30  gm 120  calories 

Milk 5  ounces 150  c.c 100 

Junket  tablet }4 0.25  gm. 

Cold  water 1  ounce 30  c.c. 

Vanilla few  drops. 

See  directions  for  Cocoa  Junket. 

Baked  Custard 

Milk  sugar 1}4  ounces 40  gm 160  calories 

Milk 6  ounces 180  c.c 120 

Egg 1  (whole) 50  gm 80 

Nutmeg  or  vanilla. 

Salt a  speck. 

Beat  the  egg  slightly ;  warm  the  sugar  and  milk,  stirring  constantly ; 
add  to  the  egg,  strain  into  a  custard  cup,  and  flavor.     Bake  in  a  pan  of 


PUDDINGS  651 

water  in  a  moderate  oven  until  a  knife,  when  cut  into  it,  will  come  out 
clean  (one-half  to  one  hour). 

PUDDINGS 

Bread  Pudding — 

Milk  sugar 13^  ounces 45  gm 180  calories 

Milk 6  ounces 180  c.c 120 

Egg 1  (whole) , .  50  gm 80 

Bread 1  sUce  H" thick. ! .  20    «   60 

Butter )4  ounce 15    «   120 

Spread  the  bread  with  butter,  and  cut  into  squares.  Beat  the  egg 
slightly ;  heat  the  milk  and  sugar,  stirring  constantly ;  mix  with  the  eg^ 
and  pour  over  the  bread.  Grate  nutmeg  over  the  top,  and  bake  the  same 
as  custard. 

Rice  Pudding 

Rice 3  tablespoonfuls.  . .  100  gm 360  calories 

Milk 1  quart 500  c.c 700 

Salt a  pinch 1  gm. 

Sugar 1  cup 280    «   1,148       « 

Butter 1  hp.  teaspoonful.  .15    "   120       "■ 

Cinnamon,  nutmeg,  or  vanilla  to  taste. 

Wash  the  rice  with  water.  Add  to  the  milk  and  cook  slowly  on  top 
of  the  stove  for  one  hour,  or  a  little  longer,  until  the  mixture  becomes 
creamy.  Add  the  sugar,  butter  and  cinnamon.  Put  into  a  dish  to  set, 
and  bake  in  an  oven  until  the  top  is  browned.  The  whole  pudding  fur- 
nishes five  to  six  portions. 

Rice  and  Egg  Pudding  (Caultey). — 

Rice 3  ounces 90  gm 315  calories 

Milk 1  pmt 500  c.c. 350 

Butter 1  ounce 30  gm 240 

Powdered  sugar 2  ounces 60    "   240       " 

Eggs 3  yolks 54    «   180       " 

Lemon  peel 1  grated 2    " 

Eggs 3  whites 96    «   54       « 

Powdered  sugar 3  tablespoonfuls.  . .  45    "    185       " 

Take  the  rice  and  swell  it  gently  in  the  new  milk.  Let  it  cool,  and 
stir  well  into  it  the  fresh  butter,  powdered  sugar,  the  yolks  of  the  eggs, 
and  some  gTatcd  lemon  peel.  Pour  into  a  well-buttered  dish  and  put  on 
the  top  the  whites  of  the  eggs  beaten  with  the  powdered  sugar.  Bake  for 
twenty  minutes  until  lightly  browned.  The  whole  pudding  furnishes  six 
portions. 

Arrowroot  (Pavy). — IMix  thoroughly  two  teaspoonfuls  of  arrowroot 
with  three  tablespoonfuls  of  cold  water,  and  pour  on  them  half  a  pint 


652    PKEPARATION  OF  SPECIAL  BEVEEAGES  AND  FOODS 

of  boiling  water,  stirring  well  meanwhile.  If  the  water  is  boiling,  the 
arrowroot  thickens  as  it  is  poured  on,  and  nothing  more  is  necessary.  If 
only  warm  water  is  used,  the  arrowroot  must  be  afterward  boiled  until 
it  thickens.  Sweeten  with  loaf  sugar,  and  flavor  with  lemon  peel  or  nut- 
meg, or  add  sherry,  port  wine  or  brandy,  if  required.  Boiling  milk  may 
be  employed  instead  of  water,  but  when  this  is  done  no  wine  must  be 
added,  as  the  milk  would  curdle. 

Cornstarch  Pudding  (Individual  Rule)  (Pattee). —  . 

Milk 1  cupful 250  c.c 170  calories 

Cornstarch 13^  tablespoons ....  28  gm 90       " 

Sugar VA  "  ....28    "    112 

Salt a  speck 1    " 

Egg 1  white 32    «   18       « 

Vanilla  extract a  few  drops. 

Scald  the  milk  in  a  double  boiler.  Mix  cornstarch,  sugar  and  salt 
thoroughly;  add  slowly  the  scalded  milk,  stirring  constantly.  Return  to 
top  of  boiler  and  cook  twenty  minutes,  stirring  constantly  for  the  first  five 
or  six  minutes,  then  occasionally.  Remove  from  fire,  and  while  very  hot, 
fold  in  lightly,  but  thoroughly,  the  well-beaten  white  of  egg.  When  par- 
tially cooled  add  flavoring  to  taste ;  put  into  wet  cups  or  molds,  cool,  and 
then  stand  for  several  hours  on  ice.  Remove  from  molds.  Serve  with  a 
soft  custard,  mashed  fresh  berries,  or  whipped  cream.  Vary  the  pudding 
by  adding  a  little  Walter  Baker's  chocolate,  melted. 

Pineapple  Cream  (Individual  Rule)   (Pattee). — 

Milk 1  cupful 250  c.c 170  calories 

Cornstarch 1]4  tablespoons ....  28  gm 90       " 

Sugar VA  "  ....28    "   112       « 

Salt a  speck 1    " 

Egg 1  white 32    "   18       « 

Grated  pineapple 2  tablespoons 50    "   22       " 

Follow  directions  for  Cornstarch  Pudding,  adding  the  pineapple  in- 
stead of  vanilla.     Pour  into  individual  molds  and  serve  cold  with  cream. 

Plain  Rice  Pudding  (Individual  Rule). — 

Steamed  rice 1  cupful 300  gm 300  calories 

Scalded  milk 1      "     250  c.c 170 

Butter 1  tablespoonful. ...   15  gm 120  " 

Egg 1  (whole) 50    «   80  " 

Sugar 2  tablespoonfuls.  . .  30    «    120  " 

Salt A  saltspoon 1    " 

Raisins  (stoned) M  cup :  .100    «   320  « 


PUDDINGS  653 

Scald  milk  and  add  butter.  Beat  egg,  add  sugar  and  salt,  and  pour  on 
slowlj  the  scalding  milk.  Put  in  pudding  dish  with  rice  and  raisins.  Put 
bits  of  butter  on  top,  and  bake  in  a  moderate  oven  until  custard  is  set. 
Serve  with  hard  sauce.     Do  not  use  raisins  in  cases  of  bowel  trouble. 

Chocolate  or  Cocoa  Blancmange  (Pattee). — 

Minute  tapioca ]/i  cupful 30  gm 45  calories 

Sugar \i      «     30    "    120       " 

Salt K  teaspoonful 1    " 

Hot  chocolate  or  cocoa V/i  cups 340    "   418       " 

Vanilla ^  teaspoonful. 

The  above  quantity  is  sufficient  for  three  servings  containing  195 
calories  each. 

Mix  tapioca,  sugar  and  salt ;  pour  on  gradually  the  hot  cocoa,  and  cook 
in  double  boiler  about  twenty  minutes.  Remove  from  heat,  add  vanilla, 
and  pour  into  cold,  wet  molds.  Serve  cold,  plain  or  with  whipped  cream 
or  soft  custard. 

Plain  Bread  Pudding  (Pattee). — 

Stale  bread 1  cupful 120  gm 120  calorics 

Milk 1       "     250  c.c 170 

Butter 1  tablespoonful 15  gm 120       " 

Egg 1  (whole) 50    "   80 

Sugar  to  taste 2  tablespoonfuls.  . .  30    «    120       « 

Salt H  saltspoon 1     " 

Seeded  raisins M  cup 100    «   320       « 

Scald  milk  and  add  butter.  Beat  the  ^^^'g  and  add  sugar  and  salt ;  pour 
on  gradually  the  scalding  milk.  Cut  the  bread  into  one-half  inch  cubes 
and  add  with  the  raisins.  Pour  into  well-buttered  pudding  dish,  put  bits 
of  butter  on  top,  and  bake  in  a  moderate  oven  until  the  custard  is  set. 
Serve  with  hard  sauce  or  cream  and  sugar.  Do  not  use  raisins  in  bowel 
trouble.  The  above  quantity  is  sufficient  for  two  servings  and  contains 
930  calories. 

Tapioca  and  Sago  Pudding  (Watson). — 

Tapioca  or  sago ^  ounce 30  gm 48  calories 

Gold  milk V^  pint 250  c.c 170       « 

Egg 1  (whole) 50  gm 80 

Sugar 1  teaspoonful 5    '' 20 

Flavoring to  taste. 

Tf  small  crushed  tapioca  or  sago  is  used,  the  directions  are  the  same 
as  for  semolina  pudding.    If  not,  the  recipe  is  as  follows : 


654    PREPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

Cover  the  grain  with  milk,  and  soak  for  an  hour.  Rinse  out  a  small 
lined  saucepan,  turn  the  tapioca  and  milk  into  it,  and  stir  over  the  fire 
until  it  comes  to  the  boil.  Then  simmer  slowly  until  it  turns  clear,  stir- 
ring every  now  and  then.  This  takes  from  twenty  to  thirty  minutes.  If 
it  becomes  too  thick  while  cooking,  add  a  little  more  milk.  Then  finish 
off  the  pudding  with  eggs,  etc.,  as  in  semolina. 

Baked  Bread  and  Butter  Pudding  (Watson). — 

Thin  bread  and  butter 2  slices  {%"  thick).  . .  40  gm 120  calories 

Sugar 1  teaspoonful 5    " 20 

Milk K  pint 250  c.c 170 

Egg 1  (whole) 50  gm 80       « 

Grated  nutmeg to  suit. 

Cut  some  bread  and  butter  rather  thin,  remove  the  crusts,  and  cut  into 
pieces  about  an  inch  square.  Lay  these  into  a  small  greased  pie-dish,  mak- 
ing the  dish  just  about  half  full;  beat  up  the  egg  in  a  small  basin,  and 
add  the  nutmeg,  sugar  and  milk.  Mix  well  together  and  pour  over  the 
bread  in  the  pie-dish.  Allow  the  pudding  to  stand  about  ten  minutes  until 
the  bread  gets  thoroughly  saturated,  then  bake  in  a  moderate  oven  from 
ten  to  fifteen  minutes  until  nicely  browned  on  the  top.  Sprinkle  with 
sugar. 

Sponge  Pudding  (Wegele). — 

Butter %  ounce 20  gm 170  calories 

Flour 1%  ounces 50    "    180 

Milk K  pint  {]i  pound).  .  .250  c.c 170 

Egg 1  yolk 18  gm 65 

Butter ^  ounce 20    "   160       " 

Eggs 2  yolks 36    «   130 

Sugar 1  tablespoonful 15    "   60       " 

Vanilla a  little. 

Eggs 3  whites 96    «   54 

Melt  the  butter  in  a  saucepan.  Thoroughly  mix  the  flour  and  milk, 
boil  in  the  saucepan  containing  the  melted  butter.  Let  the  mixture  cool 
off,  and  then  add  the  yolk  of  the  one  egg.  Beat  to  a  cream  the  butter  and 
yolks  of  two  eggs,  add  sugar  and  vanilla,  and  add  to  above.  Beat  stiff 
the  whites  of  three  eggs  and  add.  Butter  a  pudding  dish,  dust  same  with 
bread  crumbs,  put  the  entire  batter  into  the  pudding  dish  and  allow  to 
steam  for  one  hour.  One  hundred  grams  (31/4  oz.)  are  equivalent  to 
about  220  calories. 

A  vanilla  or  wine  sauce  may  be  served  with  this  pudding.  The  pud- 
ding can  be  baked,  if  so  desired. 


ICE    CREAM  656 

ICE  CREAM 

Chocolate  Ice  Cream  (Pattee). — 

Tliin  cream Yi  cup 80  gm 216  calories 

Walter  Baker's  chocolate 1  ounce 30    "    180 

Sugar 13^  tablespoonfuls. .  15    «    60 

Boiling  water 1  tablespoonful. ...  15  c.c. 

Vanilla 3^  teaspoonful 1    " 

Salt a  speck 0.5  gm. 

Melt  the  chocolate  over  hot  water,  add  the  boiling  water,  sugar  and 
hot  cream.     Cool,  add  vanilla  and  salt,  and  freeze  in  small  pail. 

Junket  Ice  Cream  (Pattee). — 

Cream 3^  cup 80  gm 216  calories 

Milk ^    "   125  c.c 85 

Sugar 2K  tablespoons 25  gm 100 

Hansen's  junket  tablet }/i  tablet 

Cold  water 2  teaspoonfuls 15  c.c. 

Vanilla %  "  25    " 

Heat  the  milk  until  lukewarm,  add  the  sugar  and  vanilla ;  when  sugar 
is  dissolved,  add  the  tablet  dissolved  in  the  cold  water.  Allow  it  to  stand 
in  warm  room  until  firm,  then  beat  thoroughly  and  turn  into  small  pail 
and  freeze.     The  above  quantity  is  sufficient  for  two  servings. 

A  variety  may  be  made  by  adding  two  teaspoons  cocoa  dissolved  in  a 
little  boiling  water.  Add  to  mixture  before  adding  the  tablet.  Serve  the 
cream  plain  or  with  whole  strawberries,  etc.  The  junket  improves  the 
body  or  consistency  of  any  cream. 

Strawberry  Ice  Cream  (Pattee). — 

Thin  cream  or  rich  whole  milk . .  >^  cup 80  gm 216  calories 

Milk -K    "   125  c.c 85       " 

Strawberries M    "   200  gm 60       « 

Sugar 2  tablespoons 20    "    80       « 

Salt a  speck 1    " 

Mash  the  strawberries  with  the  sugar,  and  allow  them  to  stand  five 
minutes.  Add  the  cream  and  milk  and  freeze  in  small  pail.  The  berries 
may  be  mashed  and  strained  through  cheesecloth. 

Peach  Ice  Cream  (Pattee). — 

Thin  cream  or  rich  whole  milk . .  3^  cup 80  gm 216  calories 

Milk Yi    "   125  c.c 85       " 

Peaches M    "   256  gm 85       " 

Sugar 2  tablespoons 20    "   80 


656    PEEPARATIOK  OF  SPECIAL  BEVERAGES  AND  FOODS 

Mix  peaches  and  sugar  and  press  through  a  potato  ricer  or  sieve. 
Scald  cream  and  milk.  Cool,  and  add  peaches  and  sugar.  Freeze  in 
small  pail. 

Caramel  Ice  Cream  (Individual  Rule)   (Pattee). — 

Thin  cream  or  rich  whole  milk .  .3^  cupful 80  gm 216  calories 

Milk 3^      "     125C.C 85       « 

Sugar 2  tablespoonfuls.  . .  30    "   80       " 

Boiling  water 2  "  ...  30    « 

Vanilla H  teaspoon 20    " 

Salt a  speck 1  gm. 

Into  saucepan  place  the  sugar  and  stir  constantly  until  melted.  Add 
water  and  boil  until  reduced  to  one  and  one-half  tablespoons.  Add  cream 
very  slowly,  vanilla,  salt,  and  freeze. 

Vanilla  Ice  Cream. — 

Cream 4  ounces 120  c.c. . , 240  calories 

Milk 2       «     60    "  40 

Milk-sugar 2       «      60  gm 240 

Vanilla a  few  drops 1  c.c. 

Mix  the  cream,  milk  and  sugar,  and  heat,  stirring  constantly,  until 
the  sugar  is  dissolved.    Then  flavor,  cool  and  freeze. 

RECIPES    FOR    DIABETIC    FOODS 

Gum  Gluten  Bread. — 

Gum  gluten  flour 4  cups 553  gm 1,160  calories 

Scalded  milk ■ 1  cup 250  c.c 170 

Cold  water 1     "   250    " 

Butter 1  tablespoonful. ...   15  gm 120       " 

Fleischmann's  Yeast J^  cake 2    " 

Salt }/2  teaspoonful 2    " 

Put  the  hot  water  or  milk  in  the  mixing  howl.  Add  the  butter,  and 
when  melted,  add  the  salt  and  cold  water.  Dissolve  the  yeast  in  a  little 
lukewarm  water,  and  add  to  the  above  mixture,  being  careful  that  the 
liquid  is  not  too  warm.  Stir  in  the  flour,  and  knead  thoroughly  in  the 
bowl.  Set  to  rise  in  a  warm  place,  having  the  bowl  well  covered  and 
away  from  draughts.  When  doubled  in  bulk,  cut  down,  and  knead  again 
in  the  bowl.  Cover  and  let  rise  the  second  time.  When  light,  cut  it  down, 
turn  onto  a  well-floured  board,  knead  into  shape,  and  place  in  a  greased 
bread  pan.  Cover  and  let  rise  to  top  of  pan.  Bake  in  a  moderate  oven 
one  hour  and  a  half.     Turn  out  on  a  wire  sieve  to  cool. 


KECirES    FOR    DIABETIC    FOODS  657 

Gum  Gluten  Muffins. — 

Gain  gluten  flour 1  cup 140  gm 290  calories 

Egg 1  (whole) 50    "   80 

Milk 1  cup 250  c.c 170 

Butter,  melted 1  tablespoonful. ...   15  gin 120       " 

Baking  powder 2  teaspoonfuls 8    " 

Salt ^  teaspoonful 1    " 

Sift  flour,  salt  and  baking  powder  together.  Beat  the  egg,  to  which 
add  the  milk,  and  beat  in  the  flour  gTadually,  using  Dover  egg  beater. 
Xow  add  the  melted  butter,  and  when  the  mixture  is  smooth  and  light, 
drop  in  smoking  hot,  greased  iron  gem  pans,  and  bake  forty-five  minutes 
in  a  moderate  oven. 

Aleuronat  Bread  (Ebstein). — 

Ordinary  wheat  flour 6  ounces 180  gm 600  calories 

Aleuronat  powder 6       "     180  «   576 

Butter  (best) 5       "     150  «   1,220       " 

Salt 1  teaspoonful ...     1  ** 

Baking  powder M  of  ounce 22  " 

Milk 2  ounces 60  «   85 

Mix  the  flour  and  the  aleuronat  in  a  warm  dish,  and  add  gradually  the 
melted  butter  and  milk  (made  lukewarm),  followed  by  the  salt,  and  finally 
by  the  baking  jDowder  (one  part  of  sodium  carbonate  and  two  parts  of 
cream  of  tartar).  The  dough  is  well  mixed,  then  molded  into  two  loaves, 
and  baked  at  a  good  heat. 

Bran  Bread. — 

Bran }/2  pound 280  gm. 

Ahnond  flour 2  ounces 60    "    375  calories 

Butter 3       «     90    "   720 

Eggs 6  (whole) 300    "   .480       « 

Milk H  pint 250  c.c 170       " 

Bicarbonate  of  soda 2  teaspoonfuls. . .     8    " 

Tartaric  acid 1  teaspoonful ...     4    " 

Place  the  butter  in  a  basin  and  beat  it  to  a  cream,  then  add  the  al- 
monds and  beat  well :  add  the  eggs  one  at  a  time.  Partly  mix  in  the  bran 
before  adding  the  milk.  Mix  the  whole  together,  place  it  in  a  well-but- 
tered tin,  and  bake  for  an  hour  in  moderate  oven. 

Camplin's  Bran  Cakes. — 

Wheat  bran 1  quart 543  gm. 

Eggs 3  (new  laid) 150    «    240  calories 

Butter 2  ounces 60    «    480       « 

Milk li  pint 250  c.c 170       « 

Soda-bicarbonate 1  teaspoonful 4  gm. 


658    PKEPAEATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

Take  a  sufficient  quantity  of  wheat  bran,  boil  it  in  two  successive 
waters  for  a  quarter  of  an  hour,  each  time  straining  it  through  a  sieve; 
then  wash  it  well  with  cold  water  (in  the  sieve)  until  the  water  runs  off 
perfectly  clear;  squeeze  the  bran  through  a  cloth  as  dry  as  possible,  and 
spread  it  thinly  on  a  dish ;  place  it  in  a  slow  oven ;  if  put  in  at  night,  let 
it  remain  until  the  morning,  when,  if  perfectly  dry  and  crisp,  it  will  be 
ready  for  grinding.  The  bran  thus  prepared  must  be  ground  in  a  mill 
and  sifted  through  a  wire  sieve  that  has  so  fine  a  mesh  that  a  brush  must 
be  used  to  pass  it  through;  that  which  remains  in  the  sieve  must  be  re- 
ground  until  it  becomes  quite  soft  and  fine.  Take  of  this  bran  powder 
three  ounces  (some  persons  use  four  ounces).  Mix  the  eggs  with  a  little 
of  the  milk,  and  warm  the  butter  with  the  remainder;  add  the  bran,  and 
stir  the  whole  well  together,  adding  the  soda  and  a  little  nutmeg  or  ginger 
or  any  other  agreeable  spice.  Bake  in  small  tins  (patty  pans),  which 
must  be  well  buttered,  in  a  somewhat  quick  oven  for  about  half  an  hour. 
When  baked,  the  cakes  should  be  a  little  thicker  than  a  captain's  biscuit ; 
they  may  be  eaten  with  meat  or  cheese  for  breakfast,  dinner  or  supper. 
At  tea  they  require  a  somewhat  liberal  allowance  of  butter,  or  they  may 
be  eaten  with  curd  or  with  any  soft  cheese.  It  is  important  that  the  flour 
be  prepared  as  directed  above.  If  the  cakes  do  not  keep  well  or  if  they 
have  not  been  well  prepared,  place  them  before  the  fire  for  ten  minutes 
every  day. 

Waffles 

French  gluten  flour 1  cup 140  gm 290  calories 

Eggs 2  (whole) 100    "    160 

Milk 1  cupful 250  c.c 170 

Butter 1  tablespoonful. ...   15  gm 120       " 

Baking  powder \]/2  teaspoonfuls 6    " 

Salt }4  teaspoonful 1    " 

Sift  flour,  salt  and  baking  powder  together.  Rub  in  the  butter.  Beat 
the  eggs,  to  which  add  the  milk,  and  stir  in  the  flour  gradually.  Beat 
well,  and  bake  on  a  hot,  well-greased  waffle  iron.  Serve  hot,  with  butter 
or  cream. 

Almond  Cakes  No.  1  (Saundby). — 

Almonds  (ground) 1  pound 553  gm 3,030  calories 

Eggs 4  (whole) 200    "    320 

Milk 2  tablespoonfuls.  . .  30  c.c 40       « 

Salt a  pinch 1  gm. 

Beat  up  the  eggs,  add  the  milk,  stir  in  the  almond  flour  and  salt ;  place 
in  twelve  flat  tins  and  bake  in  a  moderate  oven  for  about  fifteen  minutes. 


90  "  

720 

100  «  

160 

54  «  

195 

1  « 

92  "  

54 

RECIPES    FOR   DIABETIC    FOODS  659 

Almond  Cakes  No.  2  (Seegen). — 

Sweet  almonds 34  pound 250  gm 757  calories 

Butter '. 3  ounces 

Eggs 2  (whole) 

Eggs 3  yolks 

Salt a  little 

Eggs 3  whites 

Break  up  the  almonds  in  a  stone  mortar  (or  almond  flour  may  be  used). 
Put  the  flour  thus  prepared  into  a  linen  bag,  which  should  then  be  im- 
mersed for  one-quarter  of  an  hour  in  boiling  water,  acidwlated  with  a 
little  vinegar,  to  remove  the  small  amount  of  sugar  from  the  almonds. 
Mix  well  with  the  butter  and  two  eggs.  Then  add  the  three  yolks  of  eggs 
and  the  salt,  and  stir  the  whole  briskly  for  some  time.  Beat  the  whites 
of  eggs  to  a  fine  froth  and  add  to  the  mixture.  The  paste  is  then  made 
into  biscuits,  smeared  with  butter,  and  baked  with  a  gentle  fire. 

Cocoanut  Cakes. — 

Desiccated  cocoanut  powder.  ...  1  pound 553  gm 3,000  calories 

Yeast 1  cake 30    « 

Warm  water 2  ounces 60  c.c. 

Eggs 2  (whole) 100  gm 160       " 

Milk 2  ounces 60  c.c 80 

Salt 1  saltspoonful 1  gm. 

Mix  water  and  yeast  into  a  paste ;  add  to  cocoanut  powder,  if  neces- 
sary using  more  water.  After  thoroughly  mixing,  leave  in  a  warm  place 
for  thirty  minutes.  Beat  up  the  eggs  and  milk,  add  salt,  then  put  into 
mixing  bowl  with  the  cocoanut  powder  and  yeast;  heat  again  and  mix 
thoroughly.  Then  place  into  a  well-greased  gem  pan  containing  sixteen 
compartments.  Bake  in  a  moderately  hot  oven  for  twenty  minutes.  Al- 
mond cakes  may  be  made  in  the  same  way. 

Aleuronat  and  Almond  Cakes  (Williamson). — 

Aleuronat 3  ounces 90  gm 288  calories 

Almond  flour 3       "     90    «    561       « 

Egg 1  (whole) 50    «    80    .   « 

Cream 2  teaspoonfuls 30  c.c 108       « 

Water a  little 30    « 

Moisten  the  aleuronat  with  a  little  water  containing  saccharin  and 
let  it  stand  for  a  few  minutes;  then  add  the  almond  flour,  the  e^rg^  the 
cream,  and  the  water  just  as  required  to  make  a  light  paste.  Spread  on 
a  tin.    Cut  into  squares,  and  bake  in  a  moderate  oven  for  twenty  minutes. 


660    PREPAEATIOX  OF  SPECIAL  BEVERAGES  AND  FOODS 

Almond  Biscuit  (Mrs.  Hart). — 

Almond  flour 1  pound 553  gm 3,030  calories 

Eggs 2  whites 64    "   36 

Salt  to  taste ^  teaspoonful 1    " 

To  the  flour  add  the  whites  of  the  eggs  and  salt.  Whip  the  whites 
to  a  stiff  froth,  add  the  almond  flour,  and  beat  well  together.  Put  in  but- 
tered patty  pans  and  bake  in  a  moderately  quick  oven  for  from  fifteen  to 
twenty  minutes.  The  whole  must  be  done  quickly,  and  baked  as  soon  as 
the  ingredients  are  mixed.     This  biscuit  is  a  useful  substitute  for  bread. 

Aleuronat  Pancakes  (Williamson). — 

Egg 1  (whole) 50  gm 80  calories 

Water  and  cream a  little 30  c.c 54       " 

Aleuronat  powder 2  teaspoonf uls 30  gm ."....  187       " 

Baking  powder ^  teaspoonful 2    " 

Salt a  little 1    " 

Beat  up  the  egg  in  the  water  and  cream ;  mix  the  aleuronat  powder, 
baking  powder  and  salt,  and  then  add  gradually  to  the  egg  and  cream  and 
beat  into  a  batter;  allow  it  to  stand  for  five  minutes.  If  it  is  too  thick, 
add  a  little  more  cream  and  water.  Fry  in  an  ordinary  frying-pan 
greased  with  a  little  lard.  At  the  end  of  about  eight  minutes,  when  the 
under  surface  is  browned,  turn  it  over  and  continue  to  bake  for  five  min- 
utes longer. 

Aleuronat  and  Suet  Pudding  (Williamson). — 

Aleuronat  floiu-! 2  ounces 60  gm 374  calories 

Suet 2      "     60    "   540 

Egg 1  (whole) 50    " 80       « 

Salt a  pinch 1    " 

Baking  powder Yi  teaspoonful 2    " 

This  is  a  palatable  and  cheap  dish.  Sprinkle  a  little  aleuronat  flour 
on  a  chopping-board  and  chop  the  suet  on  this  part  of  the  board.  Then 
mix  the  remaining  aleuronat  with  the  suet  in  a  pan.  Add  the  salt  and 
the  baking  powder.  Beat  up  the  egg  in  about  three  tablespoonfuls  of 
water  to  which  a  little  saccharin  has  been  added.  Add  the  egg  gradually  to 
the  suet  mixture,  rubbing  the  whole  mass  well  into  a  paste.  It  may  be  nec- 
essary to  add  a  little  more  water.  Drop  into  a  tin  pudding  mold  smeared 
with  butter  or  lard,  float  it  in  a  pan  of  water,  and  boil  for  two  hours,  tak- 
ing care  that  the  boiling  water  does  not  get  into  the  mold ;  or,  better  still, 
the  pudding  may  be  baked  in  the  oven.    Its  taste  is  improved  by  the  addi- 


RECIPES    FOR    DIABETIC    FOODS  661 

tioii  of  half  an  ounce  of  almonds.     A  small  quantity  of  i"ed  wine  may 
serve  as  a  sauce. 

Cocoanut  Pancakes  (Williamson). — 

Egg 1  (whole) 50  gm 80  calories 

Milk 2  tablespoonfuls.  . .  30  c.c 25       " 

Salt a  pinch 1  gm. 

Cocoanut  powder 2  tablespoonfuls.  . .  30    "    187       " 

Beat  up  the  egg  in  the  milk,  or,  better,  in  a  little  cream  and  water, 
and  add  the  salt.  Then  add  tlie  cocoanut  powder  (freed  from  sugar).  Al- 
low this  to  stand  from  five  to  ten  minutes.  Add  a  little  more  cream 
and  water.  Mix  well  until  it  is  a  little  thicker  than  ordinary  pancake 
batter.  Put  a  little  lard  in  the  frying-pan  and  heat  until  the  lard  is  just 
melted;  then  drop  in  half  of  the  mixtura  Allow  this  to  remain  over  a 
moderate  fire  for  a  few  minutes — about  five — until  the  under  surface  is 
brown;  then  turn  the  cake  over  and  heat  for  another  five  minutes.  The 
other  half  of  the  mixture  may  be  used  for  the  second  pancake. 

Cocoanut  Cakes  (Williamson). — 

Cocoanut  powder 3  tablespoonfuls.  . .  45  gm 250  calories 

German  yeast a  little 1     " 

Water q.  s. 

Solution  of  saccharin small  quantity 0.5  " 

Egg 1  (whole) 50    "    80 

Cream 2  teaspoonfuls 30  c.c 60       " 

Mix  the  cocoanut  powder  into  a  paste  with  the  yeast  and  water.  The 
mixture  should  be  allowed  to  remain  by  the  fire  or  in  a  warm  place  for 
about  twenty  minutes,  or  until  fermentation  occurs  and  it  becomes 
"puffy."  Then  add  the  watery  solution  of  saccharin.  Beat  up  the  egg, 
and  add  this  with  the  cream  and  a  little  water  to  the  cocoanut  paste.  The 
whole  should  be  well  mixed,  dropped  into  small  tins,  and  baked  in  an  oven 
for  about  thirty  minutes. 

Cocoanut  and  Almond  Cakes  (Saundby). — 

Cocoanut  powder  (finest) ^  pound 277  gm 2,250  calories 

Ground  almonds H      "      138    "    760       « 

Eggs 6  (whole) 300    "    480 

Milk H  cupful 125  c.c 85 

Beat  up  the  eggs  and  stir  in  the  cocoanut  and  almond  flour.  Divide 
into  sixteen  flat  tins,  and  bake  for  twenty-five  minutes  in  a  moderate 
oven. 

142 


662    PREPARATION  OF  SPECIAL  BEVERAGES  AND  FOODS 

Cocoanut  Pudding  (Williamson). — 

Cocoanut  powder 3  tablespoonfuls.  . .  45  gm 275  calories 

Water a  little '30  c.c. 

German  yeast a  little 1  gm. 

Cream 4  tablespoonfuls.  . .  60  c.c 120       " 

Egg 1  (whole) 50  gm 80       " 

Salt a  little 1     « 

Water  sweetened  with  saccharin .  3^  pint 

Mix  the  cocoanut  powder  with  a  little  water  and  German  yeast,  and 
keep  for  twenty  minutes  in  a  warm  place,  so  as  to  allow  the  small  quantity 
of  sugar  present  to  decompose ;  add  the  cream,  egg,  a  little  salt,  and  water 
sweetened  with  saccharin.  Mix  into  a  paste.  Place  in  a  dish  greased  with 
butter.     Cook  like  rice  pudding,  in  a  slow  oven  for  thirty  minutes. 

Almond  Pudding  (Mrs.  Hart). — 

Eggs 2  (whole) 100  gm 160  calories 

Almond  flour M  pound 138    "    760 

Butter yi      «     140    "    900       « 

Saccharin 3  tabloids 1    " 

Brandy 1  tablespoonful. ...   15    "    100 

Warm  the  butter,  beat  in  the  almond  flour  and  the  yolks  of  the  eggs, 
and  add  the  saccharin  dissolved  in  the  brandy.  Whip  the  whites  into  a 
stiff  froth,  and  beat  all  together.  Put  into  dariole  molds  and  bake  in  a 
quick  oven.  Serve  with  a  little  hot  sauce  made  with  dry  sherry  and  sac- 
charin. 

REFERENCES 

1.  Caultey.     Sutherland's  System  of  Dietetics. 

2.  Friedenwald  and  Ruhrait.     Diet  in  Health  and  Disease. 

3.  Bartholow.     The  Practice  of  Medicine. 

4.  Thompson,  W.  Oilman.     Practical  Dietetics. 

5.  Watson.     Foods  and  Feeding. 

6.  Wegele.     Gastro-intestinal  Tract,  pub.  by  Rebman  Co.,  New  York. 

7.  Atwater,  H.  W.     Bread  and  Breadmaking,  U.  S.  Dept.  of  Agric, 

1910,  Bull.  No.  389. 

8.  Pattee.     Diet  in  Disease. 

9.  Gautier.     Diet  and  Dietetics,  Paris,  France. 
10.     Chittenden.     Am.  J.  Med.  Sci.,  vol.  vi,  No.  5. 


CHAPTEH    XVIII 

ARMY  AND  NAVY  RATIONS 

Geokge  N.  Kreider,  A.M.,  M.D.,  F.A.C.S. 

U.  S.  Army  Rations:  Garrison  Ration;  Field  Ration;  Haversack  Ration; 
Travel  Ration;  Filipino  Ration;  Emergency  Ration;  Savings;  Con- 
centrated Food;  Company  Dietaries;  Tropical  Dietaries;  Army  Ra- 
tions Past  and  Present. 

Rations  for  Boys'  Military  Training  Camps:  Menu,  Boys'  Military 
Training  Camp,  Fort  Terry,  N.  Y. ;  Properly  Balanced  Dietaries  for 
Boys'  Military  Training  Camps. 

Rations  of  Foreign  Armies:  Germany;  Russia;  Japan;  France;  Great 
Britain;  Systems  of  Supply;  Comparative  Rations  of  the  Armies  of 
the  World. 

Diet  in  Prison  Camps. 

Conclusions  Regarding  the  Composition  and  Food  Value  of  the  Military 
Ration. 

Navy  Rations. 

U.   S.   ARMY   RATIONS 

The  best  ration  for  a  soldier  is  a  subject  which  has  held  the  attention 
of  army  officers  for  many  decades.  An  army  is  a  collection  of  active, 
disciplined,  healthy  men  in  the  prime  of  life,  to  be  nsed  as  a  fighting  force 
in  the  service  of  the  nation,  and  it  is  the  prime  object  of  military  admin- 
istration so  to  govern  and  train  such  men  that  they  shall  be  fit  when 
fighters  are  needed. 

Unless  a  man  is  maintained  in  a  good  physical  condition,  he  is  use- 
less for  military  purposes.  For  this  reason  the  utmost  care  and  attention 
should  be  given  by  commanding  officers  to  every  detail  which  pertains 
to  the  health  of  the  soldier.  Improper  clothing,  food,  shelter  and  exercise 
are  all  sure  to  result  in  a  loss  of  efficiency,  but  it  is  without  question  that 
insufficient  food,  improper  food,  or  food  improperly  prepared  will  lead  to 
damage  or  disaster  more  quickly  than  any  other  cause.  A  well-balanced 
ration,  therefore,  is  the  first  and  foremost  question  to  be  considered  if  the 
individual  soldier's  efficiency  is  to  be  maintained. 

The  quantity  of  each  kind  of  foodstuff  the  soldier  shall  have  usually 
rests,  when  the  law  allows  a  choice,  with  the  department  commander.     It 

663 


664 


ARMY    AND    NAVY    RATIONS 


has  been  the  usual  custom  to  order  a  ten  days'  ration  in  which  there  are 
seven  issues  of  beef,  two  of  bacon,  and  one  of  pork.  If  the  soldier  can, 
with  the  help  of  outside  purchases,  manage  to  subsist  for  ten  days  on  the 
beef  allowed  for  seven,  he  saves  the  money  value  of  one  day's  pork  ration 
and  two  of  bacon,  and  these  savings  are  usually  turned  into  a  company 
fund  from  which  extra  food  can  be  purchased  on  holidays,  when  there 
is  a  convenient  market,  as,  for  instance,  turkey  on  Thanksgiving  and 
Christmas  and  eggs  at  Easter.  This  fund  is  considered  of  the  highest 
importance,  and  new  restrictions  are  constantly  being  thrown  around  it 
to  prevent  the  savings  from  the  ration  being  diverted  to  other  purposes. 


TEN  DAYS'  RATION  UNCOOKED  FOOD  FOR  AN  AVERAGE  DAILY  OF  440.4  MEN   (WOOD- 

RUFF(l) 


Gross 
Weight 


Waste 


Net 
Weight 


Weights  in  Pounds 


Water      Protein 


Fats 


Carbo- 
hydrates 


Salts 


Calories 


Bacon 

Beans 

Pork 

Sugar,  brown 

Flour 

Beef 

Potatoes 

Onions 

Oatmeal 

Cornmeal 

Apples,  canned 

Apples,  dried 

Tapioca  (26)  and 
cornstarch  (13) .  .  . 

Butter 

Sirup 

Lard 

Rice 

Corn,  canned 

Tomatoes,  canned. . . 

Macaroni  (51)  and 
vermicelli  (IJ^). .  . 

Milk,  fresh 

Milk,  condensed .... 

Cheese 

Prunes 

Cabbage  and  sauer- 
kraut  

Ham 

Apricots 

Barley 

Peas 

Raisins 

Chocolate 


273H 
428H 
343J^ 
731 
4,379 
5,025 
5,116 
700 
44 
85 
10 
183 

39 

58 
165 
107H 

26 

63 
332 

52^ 

31 

31 

lOH 

35 

250 
32 
20 

5 

4K 
14 

3 


3M 


31 


126H 
1,131 
1,386 

150 


50 
4 


270 
428 1^ 
U2H 
731 
4,2521^ 
3,894 
2,730 
550 
44 
85 
10 
183 

39 

58 
165 
107K 

26 

63 
332 

52^ 

31 

31 

10 

15 

200 

28 

20 

5 

10 
3 


54.00 

54.05 

37.85 

21.93 

531.56 

2,196.70 

2,943.00 

481.80 

3.34 

12.75 

8.32 

46.85 

0.78 

6.09 

70.60 

12.90 

3.22 

51.22 

318.72 

6.88 

25.61 

7.75 

3.50 

10.00 

182.00 
11.63 
13.50 

6.55 
6.45 
0.48 


21.60 
99.10 

2.82 

467.78 
682.97 
78.33 
7.70 
6.65 
7.82 
0.02 
1.65 


0.58 


0.65 
1.92 
1.77 
2.66 

4.73 
1.58 
5.27 
3.30 
0.75 

4.20 
4.68 
0.40 
0.65 
1.20 
0.05 
060 


187.65 

8.57 

259.00 

'  46.78 
978.38 
3.73 
1.65 
3.13 
3.23 
0.04 
3.30 


49.30 


89.66 
0.14 
0.70 
1.33 

0.15 
1.50 
3.41 
2.20 


0.60 
11.00 


0.14 
0.08 


253.80 


3,185.12 

667.67 

55.55 

30.01 

60.01 

1.59 

130.85 

38.14 

0.29 

90.60 

'  20.65 
8.32 
8.30 

40.32 
2.00 

13.64 
0.50 
4.00 

11.00 

6.66 
3.80 
2.54 
3.50 
0.30 


Totals 18,598 


2,908^ 


15,689)4 


7,120.50 


1,413.21 


1,657.17 


5.343  66 


6.75 

13.29 

13.14 

3.66 

21.26 

35.95 

37.30 

3.30 

0.88 

1.19 

0.03 

2.57 

0.08 
1.74 
3.80 
4.30 
0.14 
0.38 
1.00 

0.42 
0.31 
0.93 
0.50 
0.25 

2.20 
0.76 
0.12 
0.15 
0.12 
0.08 
0.12 


831,600 

691,228 
1,097,753 
1,312,081 
6,991,110 
5,409,392 
1,398,750 

123,750 
81,400 

139,825 
3,150 

259,494 

70,980 
209,670 
168,795 
383,775 
42,380 
21,735 
26,560 

73,815 
12,552 
49,442 
16,000 
3,500 

31,000 
54,880 
9,200 
9.000 
7,043 
6,153 
7,950 


154.82 


19,446.960 


Daily  average  per 
man 

Counting  flour 
bread,  amount  eat- 
en is  4  lb.  per  man 
Per  cent  of  amount 
eaten 

Including  Table  V 
(salts  only)  gms 

Including  estimated 
amounts  in  Tables 
VI  and  VII.. 


Pounds 

Grams 

4.22 

66,15J? 

3.56,84^'{ 

733 

145 

171 

550 

16 

45 

9 

11 

34 

1 

733 

5 

H 

VA.  (2.8 

lb.)  wat«r 

free 

4,416 


U.  S.  AKMY   RATIONS 


665 


PERCENTAGE  OF  WASTE 


Bacon 

1.40 
8.00 

3.30 
22.50 
27.09 
21.04 
33.00 
45.00 
12.00 

Pork 

Only  9  pounds  were  reported,  but  this  was  in- 
creased in  31  pounds,  to  include  bones,  etc. 
Crusts  and  small  unavoidable  wastes 

Bread 

Beef 

19^  bone,  2%  fat,  and  other  wastes 

Potatoes 

Parings  and  defective  ones 

Onions 

Parings  and  defective  ones 

Prunes   

Stones  and  other  wastes 

Cabbage 

Ham 

Estimated 

ADDITIONAL  ARTICLES  CONSUMED 


Daily  per 
man 

Allowance 

Remarks 

338  lbs.  green  coffee .  . . 

1.23  ounces 

1.60  ounces 

8  lbs.  tea 

0.03  ounce 

0.32  ounce 

rAUowance  is  large  to  allow  of  a 

saving  to  be  used  in  making 

20  gallons  vinegar. .  . . 

0.14  gill 

0.32  gill 

sauerkraut  and  pickles  in  the 
I    fall 

10  lbs.  pepper 

0.036  ounce 

0.04  ounce 

11  bottled  flavoring  ex- 

tracts 

3  lbs.  mustard 

24  lbs.  baking  powder. 

6  lbs.  currants 

5  gallons  pickles 

r  Though  containing  much  energy, 

4  kegs   pickled   pigs' 

it  is  omitted  because  composi- 

feet  

tion  is  unknown,  and  the  actual 

I    amount  per  man  is  very  small 

CONSUMPTION  AND  ALLOWANCE  PER  MAN 


Daily  per 
man 


Allowance 


Remarks 


4  379  lbs.  flour 

4.946^  lbs.  bread .  . 

34'iH    "    pork. . 

27334    "    bacon.. 

5,025  lbs.  beef 

5,116    "    potatoes. 

700    "    onions.  . 

4283^  lbs.  beans. 

763  lbs.  sugar .  . . 
64    «    butter... 

137    "    lard .... 
15  gallons  sirup . 


ounce 
ounces 


15.91  ounces 

17.97  « 
1.34  « 
1.00 

18.30 

18.50  " 
2.50  « 
1.50  " 
2.70  " 
2.00  " 
0.50  « 
0.40  gill 


18 

18 
1.2 
2.4 

18.0 

12.8 
3.2 
2.4 
2.4 


ounces 


Includes  purchases 


80  per  cent  of  vegetables 
20  per  cent  vegetables 


666  AEMY    AND    NAVY    RATIONS 

A  ration(2)  is  the  allowance  for  the  subsistence  of  one  person  for  one 
day  and  varies  in  components  according  to  the  station  of  the  troops  or  the 
nature  of  the  duty  performed.  The  garrison  ration  is  for  troops  in  gar- 
rison or  in  permanent  camps ;  the  jield  ration  is  for  troops  in  the  field  with 
sufficient  transportation ;  the  lim^ersach  ration  for  troops  in  the  field  in 
active  campaign,  when  transportation  is  limited ;  the  travel  ration  for 
troops  traveling  otherwise  than  by  marching  and  separated  from  cooking 
facilities ;  the  Filipino  ration  for  use  of  the  Philippine  Scouts,  and  the 
emergency  ration  for  troops  in  active  campaign  for  use  on  occasions  of 
emergency.  The  commanding  officer  will  determine  which  of  the  several 
prescribed  rations  is  appropriate  for  the  particular  service  to  be  per- 
formed, and  will  direct  the  use  of  the  same.  Army  Regulations,  1913,  p. 
1202. 

When  it  becomes  necessary  to  supplement  the  haversack  ration  in  the 
exigencies  of  forced  service,  by  local  purchase  or  by  shipments,  the  com- 
manding general  may  direct  in  written  orders  the  issue  in  kind,  to  sup- 
plement the  haversack  ration,  of  such  available  articles  of  food  as  are 
actually  necessary,  not  in  excess  of  the  amounts  allowed  of  corresponding 
articles  in  the  garrison  ration. 

The  tables  on  pages  667-668  are  taken  from  the  United  States  Army 
Regulations,  p.  1202(3),  which  read:  "The  kinds  and  quantities  of  the 
component  articles  of  the  ration  and  the  substitutive  equivalent  articles 
which  may  be  used  in  place  of  such  components  shall  be  as  follows" : 

Colonel  Harvard,  Medical  Corps,  U.  S.  A.,  in  his  splendid  work  on 
Military  Hygiene (4),  describes  the  various  rations  for  the  soldier,  from 
which,  with  his  permission,  several  sections  are  quoted  herewith: 

"The  garrison  ration,  as  may  be  seen,  admits  of  many  combinations 
which  insure  variety.  It  is  comprehensive  and  elastic,  and  can  be  ad- 
justed to  any  climate.  By  selecting  the  most  nutritive  articles,  such  as 
bacon,  hard  bread  or  cornmeal,  beans,  potatoes,  dried  fruit,  butter  and 
sirup,  we  can  obtain  from  it  a  maximum  fuel  value  of  5,378  calories, 
according  to  Langworthy,  or  5,674  calories,  according  to  Wiley.  On  the 
other  hand,  by  using  such  articles  as  dried  fish,  soft  bread,  rice,  potatoes, 
canned  tomatoes  and  dried  fruit,  the  fuel  value  can  be  reduced  to  2,500 
calories.  The  average  garrison  ration,  habitually  consisting  of  fresh  beef, 
soft  bread,  beans,  potatoes  and  onions,  dried  fruit,  butter,  sirup  and 
sugar  (or  their  nutritive  equivalents),  weighs  65  ounces  and  contains  99 
grams  of  fat,  481  of  carbohydrates  and  157  of  proteins,  with  total  fuel 
value  of  3,536  calories (4). 


U.  S.  ARMY    RATIONS 

GARRISON  RATION  ' 


667 


COMPONENT  ARTICLES  AND 
QUANTITIES 


Beef,  fresh 20 


ounces 


Flour. 


.18 


Baking  powder. 
Beans 


0.08 
2.4 


Potatoes'' 20 


SUBSTITUTIVE  ARTICLES  AND 
QUANTITIES 

Mutton,  fresh 20        ounces 

Bacon* 12  « 

Canned  meat,  when  imprac- 
ticable   to    furnish    fresh 

meat 16  " 

Hash,  corned  beef,  when  im- 
practicable     to      furnish 

fresh  meat 16  ** 

Fish,  dried 14  « 

Fish,  pickled 18  « 

Fish,  canned 16  * 

Chicken  or  turkey,  dressed, 
on  national  holidays  when 

practicable 16  " 

Soft  bread 18  « 

Hard  bread,  to  be  ordered 
issued  only  when  im- 
practicable to  use  flour  or 

soft  bread 16  « 

Corn  meal 20  « 

Rice 1.6        « 

Hominy 1.6        ** 

Potatoes,  canned 15  " 

Onions,  in  lieu  of  an  equal 
quantity  of  potatoes,  but 
not  exceeding  20  per  cent 
of  total  issue. 
Tomatoes,  canned,  in  lieu  of 
an     equal     quantity     of 
potatoes,  but  not  exceed- 
ing 20  per  cent  of  total 
issue. 
Other  fresh  vegetables  (not 
canned)  when  they  can  be 
obtained  in  the  vicinity  or 
transported    in    a   whole- 
some condition  from  a  dis- 
tance, in  lieu  of  an  equal 
quantity  of  potatoes,  but 
not  exceeding  30  per  cent 
of  total  issue. 
Apples,  dried  or  evaporated .   1 .  28       " 
Peaches,  dried  or  evaporated  1 .  28       " 


1  Food  for  troops  travolinjj  on  United  States  Army  transports  will  hv  prepared  from 
the  articles  of  subsistence  stores  which  compose  the  ration  for  troops  in  garrison, 
varied  by  the  substitution  of  other  articles  of  authorized  subsistence  stores,  the  total 
cost  of  the  food  consumed  not  to  exceed  24  cents  per  man  per  day. 

2  In  Alaska,  10  ounces  bacon,  or,  when  desired,  10  ounces  salt  pork,  or  22  ounces 
salt  beef. 

:'  In  Alaska  the  allowance  of  fresh  vegetables  will  be  24  ounces  instead  of  20  ounces, 
or  canned  potatoes,  18  ounces  instead  of  l.'j  ounces. 


668 


ARMY    AND    NAVY    RATIONS 


COMPONENT  ARTICLES  AND 
QUANTITIES 

Prunes^ 1 .  28  ounces 

Coffee,  roasted  and  ground.   1.12      " 

Sugar... 3.2 

Milk,  evaporated,  unsweet- 
ened    0.5        " 

Vinegar 0. 16  gill 

Salt 0 .  64  ounce 

Pepper,  black 0.04     « 

Cinnamon 0.014  « 

Lard 0.64     « 

Butter 0.5 

Sirup 0.32  gill 

Flavoring  extract,  lemon ...   0.014  " 


SUBSTITUTIVE  ARTICLES  AND 
QUANTITIES 


Jam,  in  lieu  of  an  equal  quan- 
tity of  prunes,  but  not  ex- 
ceeding 50  per  cent  of  total 
issue. 
Coffee,  roasted,  not  ground .   1.12  ounces 

Coffee,  green 1.4         " 

Tea,  black  or  green 0 .  32      " 

Pickles,  cucumber,  in  lieu  of 
an  equal  quantity  of  vine- 
gar, but  not  exceeding  50 
per  cent  of  total  issue. 


Cloves 0. 014  ounce 

Ginger 0.014      « 

Nutmeg 0.014      « 

Oleoraargarin 0.5  " 

Vanilla 0.014      « 


1  At  least  30  per  cent  of  the  issue  to  be  prunes  when  practicable. 


''Fresh  meats  are  ordinarily  issued  seven  days  in  ten,  and  bacon  three 
days. 

''The  garrison  ration  is  often  supplemented  by  articles  obtained  from 
the  post  garden  or  purchased  from  the  company  fund,  which  largely  con- 
tribute to  give  it  variety  and  appetizing  value. 

"In  order  to  facilitate  the  supplying  of  troops  and  the  keeping  of  ac- 
counts, the  former  system  of  issue  has  been  replaced  by  that  of  purchase. 

"All  articles  of  the  garrison,  travel,  or  Filipino  ration  due  a  company 
or  other  military  organization,  will  be  retained  by  the  Quartermaster 
Corps,  and  credit  given  to  the  organization  for  the  money  value  of  these 
articles  at  the  current  price  of  the  articles. 

"The  stores  required  by  the  organization  will  be  purchased  from  the 
Quartermaster  Corps,  and  the  latter  will  pay  as  savings  to  the  organiza- 
tion commander  any  excess  in  value  of  the  stores  retained  over  those 
purchased.  At  the  end  of  the  month,  or  whenever  necessary,  the  organiza- 
tion commander  will  settle  the  account  with  the  Quartermaster  Corps, 
when  the  savings  to  the  organization,  or  the  amount  due  to  the  Quarter- 


U.  S.  AKMY    KATIOxXS  669 

master  Corps,  as  the  case  may  be,  will  be  paid,  and  the  account  certified 
as  required. 

"The  price  of  bread,  as  charged  against  organizations,  is  determined 
by  adding  together  the  cost  of  flour  and  other  ingredients  used,  the  extra- 
duty  pay  of  the  bakery  personnel,  the  cost  of  the  power  used  in  operating 
the  baking  machinery,  and  then  dividing  by  the  total  number  of  pounds 
of  bread  baked.  It  follcnvs  that  the  organizations  are  thus  given  the  bene- 
fit of  whatever  savings  accrue  from  the  conversion  of  flour  into  bread  after 
deduction  of  all  expenses. 

"Money  accruing  from  the  'ration  and  savings  account'  of  an  organi- 
zation will  be  spent  only  for  food. 

"All  articles  of  the  ration  required  for  the  supply  of  troops  will  be 
obtained  from  the  Quartermaster  Corps  when  on  hand,  but  should  any 
organization  want  more  of  any  article  than  is  allowed  by  regulation,  the 
excess  may  be  purchased  elsewhere ;  or  if  any  article  is  not  in  stock,  it  can 
likewise  be  bought  elsewhere. 

"When  necessary  to  renew  reserve  rations,  or  to  avoid  loss  of  ration 
articles  that  have  accumulated,  the  commanding  general  or  commanding 
officer,  as  the  case  may  be,  may  order  the  issue  of  such  supplies  to  troops, 
not  to  exceed  the  ration  allowance  and  only  for  such  time  as  the  interest 
of  the  Government  requires. 

"The  value  of  the  garrison  ration  is  estimated  at  twenty-five  cents ;  the 
Filipino  ration  at  twenty  cents,  and  the  travel  ration  at  forty  cents. 

"Under  circumstances  when  enlisted  men  or  nurses  cannot  be  furnished 
with  rations  in  kind,  or  it  is  impracticable  to  carry  them,  commutation 
may  be  allowed  at  rates  ranging  from  twenty-five  cents  to  $1.50  a  day. 

"The  ration  of  enlisted  men  sick  in  hospital,  and  of  female  nurses 
while  on  duty  in  hospital,  is  commuted  at  the  rate  of  thirty  cents  per 
ration,  except  that  at  the  general  hospital  at  Fort  Bayard,  N.  M.,  fifty 
cents  per  ration  is  authorized  for  enlisted  patients  therein. 

"Other  issues  of  stores,  not  components  of  rations,  may  be  authorized 
when  necessary  for  the  public  service  and  made  on  ration  returns  ap- 
proved by  the  commanding  officer,  such  as  soap,  candles,  matches,  toilet 
paper,  towels  and  ice. 

"Ice  is  issued  by  the  Quartermaster  Corps  to  organizations  of  enlisted 
men  as  follows :  for  each  ration,  four  pounds,  the  maximum  allowance  to 
any  organization  or  detachment  of  less  than  100  men  to  be  100  pounds 
a  day,  and  to  organizations  of  100  men  or  more  to  be  one  pound  a  day, 
per  man.    The  full  allowance  may  be  issued  for  the  entire  year  to  troops 


670 


ARMY   AND    NAVY    RATIONS 


stationed  south  of  the  37th  parallel.  To  troops  stationed  north  of  the 
37th  parallel,  and  where  from  any  cause  it  is  impracticable  to  cut  and 
store  ice  for  their  use,  the  allowance  will  be  only  for  the  summer  months, 
from  April  1  to  October  31.  A  special  allowance  is  provided  for  States 
on  the  Pacific  Coast (4)." 

FIELD  RATION 


COMPONENT  ARTICLES  AND 
QUANTITIES 


Beef,  fresh,  when  procura- 
ble locaUy 20 

Flour ■ 18 

Baking  powder,  when  ovens 

are  not  available 0 .  64 

Yeast,  dried  or  compressed, 

when  ovens  are  available .  0 .  04 
Beans 2.4 


ounces 


Potatoes,    when   procurable 
locally 16 

Jam 1.4        " 

Coffee,  roasted  or  ground ...   1.12      " 

Sugar 3.2 

Milk,  evaporated,  unsweet- 
ened   0.5 

Vinegar 0.16  gill 

Salt 0 .  64  ounce 

Pepper,  black 0.04      « 


SUBSTITUTE  ARTICLES  AND 
QUANTITIES 

Mutton,    fresh,    when    pro- 
curable locally 20  ounces 

Canned  meat 16  " 

Bacon 12  « 

Hash,  corned  beef 16  " 

Soft  bread 18  « 

Hard  bread ...16  « 

Rice 1.6        «  . 

Potatoes,  canned 12  ** 

Onions,     when     procurable 

locally,  in  lieu  of  an  equal 

quantity  of  potatoes,  but 

not     exceeding     20     per 

cent  of  total  issue. 
Tomatoes,  canned,  in  lieu  of 

an  equal  quantity  of  pota- 
toes, but  not  exceeding  20 

per  cent  of  total  issue. 

Tea,  black  or  green 0.32      « 


Pickles,  cucumber,  in  lieu  of 
an  equal  quantity  of  vine- 
gar, but  not  exceeding  50 
per  cent  of  total  issue. 


The  field  ration  is  the  ration  prescribed  in  orders  by  the  commander 
of  the  field  forces.  It  consists  of  the  reserve  ration  in  whole  or  in  part, 
supplemented  by  articles  of  food  requisitioned  or  purchased  locally,  or 
shipped  from  the  rear,  provided  such  supplements  or  substitutes  corre- 


U.  S.  ARMY   RATIONS 


671 


spond  generally  with  the  component  articles  or  substitutive  equivalents 
of  the  garrison  ration  (Army  Regulations,  1913,  par.  1205). 


HAVERSACK   RATION 


COMPONENT  ARTICLES  AND 

SUBSTITUTIVE  ARTICLES  AND 

QUANTITIES 

QUANTITIES! 

Bacon 12       ounces 

Hard  bread 16 

Coffee,  roasted  and  ground.   1.12      " 

Sugar 2.4 

Salt 0.16       " 

Pepper,  black 0.02      « 

1  We  would  recommend  the  use  of  malted  milk  tablets  as  an  addition  to  the  haver- 
sack field  and  travel  ration  of  the  soldier.  We  have  personally  used  these  and  feel 
assured  that  they  would  be  a  valuable  addition  from  the  viewpoint  of  compactness, 
solubility  and  the  nutrient  energy  contained. 

"The  haversack  ration  is  issued  to  troops  in  the  field  when  beyond  the 
advance  supply  depots.  It  contains  about  218  grams  of  fats,  489  of  carbo- 
hydrates and  113  of  proteins,  with  total  fuel  value  of  4,448  calories. 
Should  it  be  found  practicable  to  supplement  it  by  local  purchase  or  other- 
wise, the  commanding  general  may  direct  the  issue  in  kind  of  such  addi- 
tional articles  of  food  as  are  available,  at  whatever  cost,  but  not  in  excess 
of  the  amounts  allowed  of  corresponding  articles  in  the  garrison  ration. 

''The  bacon  is  contained  in  a  rectangular  tin  can  with  capacity  for  two 
rations.  The  sugar,  coffee  and  salt  are  contained  in  another  rectangular 
tin  can,  two  and  one-half  inches  square,  five  inches  long,  and  with  rounded 
corners ;  a  cross  partition  divides  it  in  two  compartments,  for  three  days' 
rations  of  coffee  and  sugar;  the  ends  are  closed  with  screw  covers.  The 
screw  cover  on  the  sugar  compartment  has  a  round  receptacle  two  inches 
in  diameter,  one-half  inch  deep,  closed  with  a  compression  friction  top, 
for  carrying  three  days'  rations  of  salt. 

"In  tlie  field,  bacon,  in  the  absence  of  fresh  meat,  becomes  an  invalu- 
able component  of  the  ration,  easily  kept  and  transported,  readily  digested 
when  well  cooked,  and  furnishing  abundant  energy  for  severe  muscular 
work.    A  quarter  ounce  of  soap  per  ration  is  also  issued  (in  ounce  cakes). 

"Existing  orders  prescribe  that  one  day  in  each  alternate  month  of  the 
season  of  practical  instruction,  not  exceeding  three  days  in  each  year,  the 
use  of  the  haversack  ration,  with  individual  mess-kit,  will  be  required  of 
all  troops  in  the  field  for  purposes  of  instruction  (4)." 


672 


ARMY    A^^D    NAVY    RATIONS 

TRAVEL  RATION 


COMPONENT  ARTICLES  AND 
QUANTITIES 

Soft  bread 18         ounces 

Beef,  corned 12  " 

Beaas,  baked 4  " 

Tomatoes,  canned 8  " 

Jam 1.4 

Coffee,  roasted  and  ground.   1.12       " 

Sugar 2.4 

Milk,  evaporated,  unsweet- 
ened   0.5 


SUBSTITUTIVE  ARTICLES  AND 
QUANTITIES 


Hard  bread 16  ounces 

Hash,  corned  beef 12      " 


The  fuel  value  of  this  ration  is  about  2,735  calories. 
FILIPINO   RATION 


COMPONENT  ARTICLES  AND 
QUANTITIES 


Beef,  fresh 12        ounces 

Flour 8 

Baking    powder,    when    in 

field   and   ovens   are   not 

available. 

Rice 20 

Potatoes 8  « 

Coffee,  roasted  and  ground . .   1  " 

Sugar 2 

Vinegar 0.08  gill 

Salt 0 .  64  ounce 

Pepper,  black 0.02 


SUBSTITUTIVE  ARTICLES  AND 
QUANTITIES 

Bacon 16  ounces 

Canned  meat 8       " 

Fish,  canned 12      " 

Fish,  fresh 12      « 

Hard  bread 8      « 

Onions 8      « 


•  "The  components  of  the  ration  yield  a  maximum  fuel  value  of  3,980 
calories.  As  is  well  known,  Filipinos,  like  other  Oriental  races,  manifest 
a  marked  preference  for  rice,  to  the  exclusion  of  more  nutritious  food, 
thereby  rendering  themselves  liable  to  beriberi.  To  guard  the  scouts 
against  such  possibilities,  it  is  prescribed  that  only  unpolished  rice  be 
issued  to  them  and  that  no  more  than  sixteen  ounces  per  day  be  used. 
They  are  also  required  to  use  the  entire  meat  allowance.  For  the  portion 
of  the  rice  ration  not  drawn,  1.6  ounces  of  beans  are  substitued,  while 
native  products,  such  as  camotes,  mangoes  and  squash,  are  utilized  to  as 
large  an  extent  as  possible (4)." 

Savings. — All  articles  of  the  garrison  and  travel  ration  due  a  company 
or  other  organization,  will  be  retained  by  the  quartermaster  and  credit 


U.  S.  ARMY    KATIONS  673 

given  to  the  organization  for  the  money  vahie  of  these  articles  at  the  cur- 
rent price  of  the  articles ;  and  the  quartermaster  will  pay  as  saving's  to  the 
organization  commanders  any  excess  in  value  of  the  stores  so  retained 
over  those  purchased  by  the  organization.  Such  savings  shall  be  used 
solely  for  the  purpose  of  articles  of  food. 

In  time  of  peace  the  ration  savings  privilege,  with  the  exception  here- 
inafter noted,  will  be  suspended  for  troops  on  the  march.  The  ration  to 
be  issued  to  troops  on  the  march  in  time  of  peace  will  be  prescribed  by 
the  commander  and  will  not  exceed  the  allowances  prescribed  for  the  gar- 
rison ration.  When  so  ordered  by  such  commander,  the  savings  privilege 
on  certain' specified  articles  of  the  ration  will  be  allowed (5). 

EMERGENCY  RATION 

An  emergency  ration,  prepared  under  the  direction  of  the  War  De- 
partment, will  be  issued,  in  addition  to  the  regular  ration,  as  required  for 
troops  on  active  campaign  or  in  the  field  for  purposes  of  instruction,  and 
will  not  be  opened  except  by  order  of  an  officer  or  in  extremity.  Company 
and  detachment  commanders  are  responsible  for  the  proper  care  and  use 
of  emergency  rations  carried  on  the  person  of  the  soldier. 

"The  emergency  ration  used  in  our  service,  prior  to  1910,  weighed 
twelve  ounces  net  and  consisted  of  wheat,  meat,  chocolate  and  seasoning. 
Its  preparation  was  so  elaborate  as  to  require  special  plants,  so  that,  in 
case  of  mobilization  on  a  large  scale,  the  supply  would  have  been  inade- 
quate. The  components  of  the  present  ration  are  such  as  to  be  readily 
obtained  and  prepared  to  any  extent  needed (4).     They  are  as  follows: 

Chocolate  liquor 45.45  per  cent 

Nucleo-casein 7 .  25     "     " 

Malted  milk 7.25     "     « 

Egg  albumin 14.55     "     « 

Powdered  cane  sugar 21 .  82     "     " 

Cocoa  butter 3.64     «     « 

The  chemical  analysis  shows: 

Protein 25.24  per  cent 

Amino-bodies 88     "     " 

Fat 28.05     «     « 

Carbohydrates 39.11     "     " 

Caffein  and  theobromin 17     "     " 

Ash 3.27     «     « 

"Each  ration  weighs  eight  ounces  net  and  is  put, up  in  three  cakes  of 
equal  size,  each  cake  wrapped  in  tinfoil,  and  all  three  inclosed  in  a  her- 


674  ARMY   AND    NAVY    RATIONS 

metically  sealed  and  lacquered  round-cornered  tin,  with  key-opening  at- 
tachment.    Its  fuel  value  is  1,272  calories,  and  its  cost  forty  cents. 

"From  previous  experiments  it  is  believed  that  this  ration  can  be  kept 
in  store,  even  in  the  tropics,  for  several  years  without  loss  or  deteriora- 
tion. As  a  compact  and  portable  food  preparation,  intended  to  tide  over 
a  day  or  two  until  regular  supplies  are  available,  it  is  undoubtedly  well 
adapted  to  its  purpose.  However,  there  is  serious  doubt  of  its  necessity, 
and  the  Infantry  Equipment  Board  of  1912  recommended  that  it  be  abol- 
ished and  replaced  by  the  haversack  ration,  a  recommendation  that  has 
not  yet  been  approved  (4)." 


SELECTION    OF    RATIONS 

Concerning  the  selection  of  a  ration.  Woodruff  says: 

An  army  must  be  fed  at  a  great  distance  from  the  market,  and  it  is,  there- 
fore, evident  that  the  chief  objects  in  view  in  the  selection  of  the  soldier's  food 
must  be  faeihty  of  transportation  and  ease  of  preservation  in  all  climates.  Arti- 
cles -that  are  bulky  or  easily  damaged  by  rough  handling,  and  those  that  are  not 
easily  preserved  from  decay,  are  at  once  ruled  out.  It  need  scarcely  be  men- 
tioned that  the  articles  must  be  produced  in  abundance  throughout  the  country, 
neither  imported  nor  the  particular  preparations  of  a  few  manufacturers.  Couple 
with  this  the  fact  that  the  articles  must  be  so  inexpensive  as  to  refute  any  charges 
of  extravagance,  and  it  will  be  readily  understood  that  with  a  few  exceptions 
the  ration  contains  about  all  the  articles  that  it  is  possible  to  put  in  at  present 
without  calling  on  foods  that  are  preserved,  canned,  or  otherwise  specially  pre- 
pared. 

Concentrated  Foods. — The  one  great  objection  to  prepared  foods  is  the 
ease  with  which  adulterations  and  other  frauds  can  be  perpetrated.  Qual- 
ity of  foods  can  be  easily  determined  if  seen  in  the  natural  state,  but  let 
them  be  ground  up  and  mixed  with  other  things,  and  fraud  will  be  diffi- 
cult to  detect.  It  is  a  fact  that  contractors  for  army  food,  knowing  that 
the  lives  of  the  soldiers  and  the  safety  of  the  nation  may  depend  on  the 
character  of  the  army  supplies,  will  yet  jeopardize  the  lives  of  thousands 
of  men  by  fraudulently  supplying  inferior  articles.  The  military  history 
of  the  United  States  furnishes  a  host  of  illustrations.  Operations  and 
even  campaigns  have  been  hampered  or  made  disastrous  by  faulty  food. 

Another  objection  to  concentrated  foods  as  a  sole  and  continuous  diet 
is  the  fact  that  they  do  not  furnish  sufficient  bulk.  They  may  contain 
the  proper  amounts  of  energy  and  alimentation,  yet  they  can  never  be 


U.  S.  ARMY    RATIONS  675 

used  exclusively.    They  are  not  intended  to  be  so  used  except  in  emergen- 
cies and  for  short  periods. 

Company  Dietaries. — We  give  below  a  week's  bill  of  fare  furnished 
by  two  different  company  commanders.  The  first  is  very  liberal,  and  the 
latter  far  below  the  normal  standard.  In  contrast,  they  exemplify  in  the 
most  fortunate  way  some  of  the  remarks  previously  made  as  to  the  con- 
ditions of  service  varying  the  bill  of  fare : 

COMPANY  DIETARY  AT  A  WESTERN   FORT 

Monday 
Breakfast:  Beef  stew;  fried  potatoes;  com  bread;  sirup;  bread;  butter;  coffee. 
Dinner:      Meat  pie;   mashed  potatoes;   turnips;   cabbage;   pickled  pork;   bread; 

coffee. 
Supper:      Beefsteak  with  onions;  squash  pie;  bread  and  coffee. 
Tuesday 

Breakfast:  Roast  beef;  fried  potatoes;  bread;  butter;  coffee. 

Dinner:      Pea  soup;    roast  beef;    baked  potatoes;    stewed  onions;    cauhflower; 

tapioca  pudding;   bread  and  coffee. 
Supper:      Meat  stew;  fried  carrots;  apple  pie;  bread;  coffee. 
Wednesday 
Breakfast:  Oatmeal;  milk;  meat  hash;  bread;  coffee. 

Dinner:      Sauerkraut;   pickled  pork;   mashed  potatoes;  pickled  beets;   rice  pud- 
ding; bread  and  coffee. 
Supper:      Fried  sausage  meat;  fried  potatoes;  green  com;  blancmange  pudding; 
bread  and  coffee. 
Thursday 
Breakfast:  Beefsteak  with  onions;  fried  potatoes;  bread;  coffee. 
Dinner:      Roast  beef;    mashed  potatoes;    stewed  onions;    pickled  beets;    plum 

pudding;  bread  and  coffee. 
Supper:      Fried  liver  and  bacon;  fried  carrots;  squash  pie;  bread;  coffee. 

FRmAY 

Breakfast:  Beefsteak;   fried  potatoes;  bread;  butter;  coffee. 
Dinner:      Pork  and  beans;  peach  pie;  bread;  coffee. 
Supper:      Cold  beef;  com  bread;  simp;  apple  sauce;  bread;  coffee. 
Saturday 
Breakfast:  Meat  hash;  oatmeal;  milk;  bread;  butter;  coffee. 
Dinner:      Vegetable  soup;    mashed  potatoes;   roast  beef;   pickles;   tapioca  pud- 
ding;  bread;   coffee. 
Supper:      Beef  stew;  green-apple  pie;  bread;  butter;  coffee. 

Sunday 
Breakfast:  Roast  beef;  baked  potatoes;  hot  rolls;  simp;  bread;  butter;   coffee. 
Dinner:      Sauerkraut;  pickled  pork;  mashed  potatoes;  roast  beef ;  bread;  coffee. 
Supper:      Meat  pie;  rice  pudding;  bread;  butter;   coffee. 

(Gravy  always  served  with  meats,  and  sauce  with  puddings.) 


676  ARMY   AND    KAVY    RATIOKS 

COMPANY  DIETARY  AT  A  SOUTHERN  POST 
Monday 

Breakfast:  Beef  hash  (with  onions  and  potatoes);  bread;   coffee. 

Dinner:      Rice  and  tomato  soup;  roast  beef;  roasted  potatoes;  bread. 

Supper:      Beef  (same  as  dinner);  bread;  coffee. 
Tuesday 

Breakfast:  Irish  stew;   bread;   coffee. 

Dinner:      Pea  soup  (with  toasted  bread);  roast  beef;  boiled  potatoes;   bread. 

Slipper:      Beef;  pancakes;  sirup;  bread;  coffee. 
Wednesday 

Breakfast:  Meat  hash  (with  potatoes  and  onions);  bread  and  coffee. 

Dinner:      Roast  beef;  mashed  potatoes;  plum  pudding;   bread  and  coffee. 

Supper:      Fried  liver  and  bacon;  bread  and  coffee. 

Thursday 
Breakfast:  Beef  hash;  bread  and  coffee. 
Dinner:      Baked  fresh  pork;  baked  beans;  bread  and  coffee. 
Supper:      Beefsteak;  fried  potatoes;  bread  and  coffee. 

Friday 

Breakfast:  Irish  stew;  bread  and  coffee. 

Dinner:      Rice  and  tomato  soup;  roast  beef;  boiled  potatoes;  bread. 

Supper:      Beef;  fried  potatoes;  bread  and  coffee. 
Saturday 

Breakfast:  Beef  hash;  bread  and  coffee. 

Dinner:      Rice  and  tomato  soup;  roast  beef;  boiled  potatoes;  spiced  bread  dress- 
ing;  bread. 

Supper:      Meat  pot-pie;  bread  and  coffee. 
Sunday 

Breakfast:  Friad  pork;  fried  potatoes;  bread  and  coffee. 

Dinner:      Pea  soup,  with  toasted  bread;  roast  beef;  boiled  potatoes;  bread. 

Supper:      Beef;  fried  potatoes;  bread;  coffee. 

(Gravy  always  served  with  meats,  and  sauce  with  puddings.) 

Tropical  Dietaries. — There  has  been  but  little  change  in  the  army 
ration  during  recent  years,  except  when  controlled  by  climatic  conditions ; 
the  army  in  a  cold  climate  cannot  thrive  on  the  same  diet  that  an  army 
in  the  tropics  would  do  well  on,  and  vice  versa.  In  a  cold  climate  articles 
of  the  dietary,  subjected  to  extreme  temperatures,  will  be  spoiled  by 
freezing  and  must  be  eliminated  from  the  ration.  This  will  exclude 
potatoes,  fresh  vegetables,  and  canned  goods  that  are  in  liquid  form.  On 
the  other  hand,  in  the  tropics  food  that  excessive  heat  would  spoil  or  that 
cannot  be  safely  preserved  must  be  avoided.  The  ration  under  such  cir- 
cumstances will  have  to  be  so  arranged  that  it  may  be  readily  suitable  for 
climatic  changes. 

It  is  well  known  that  our  army  in  the  Philippines  lived  on  less  food 
than  they  would  require  in  a  cold  or  temperate  climate.  This  difference 
is  marked,  more  especially,  in  the  consumption  of  meat  and  fatty  foods. 
Of  course,  if  an  army  is  undergoing  active  service  on  prolonged  marches, 


U.  S.  ARMY    RATIONS  677 

the  meat  allowance  will  have  to  be  correspondingly  increased  to  make  up 
for  the  wear  and  tear  of  the  muscular  system.  In  the  Surgeon-General's 
Report  of  the  United  States  Army  for  1900,  Major  Kean  is  quoted. 

He  premises  that  a  tropical  dietary,  as  compared  with  one  suited  to 
a  colder  climate,  should  have  less  fat  and  more  carbohydrates,  less  stim- 
ulating proteins  in  the  form  of  meat,  a  greater  variety  of  diet  both  of 
meats  and  carbohydrates  in  the  form  of  fresh  vegetables  and  fruits,  and, 
lastly,  a  fairly  liberal  supply  of  ice.  His  argument  for  the  substitution 
of  carbohydrates  for  fats  is  that  the  digestion  is  weakened  in  hot  climates 
and  the  liver  is  inclined  to  torpidity,  while  ingested  fats  are  prone  to 
split  up  into  butyric,  caproic,  and  other  irritating  acids,  which  the  dimin- 
ished secretion  of  the  liver  is  unable  to  neutralize.  As  intestinal  digestion 
cannot  proceed  in  the  presence  of  acidity,  the  condition  known  as  bilious- 
ness is  established,  with  putrefaction  of  the  intestinal  contents  and  the 
production  of  various  harmful  alkaloid  substances.  A  catarrhal  in- 
flammation of  the  bowel  results,  with  diarrhea,  which  is  at  first  of 
advantage  in  eliminating  the  harmful  substances,  but  which  under  the 
continued  irritation  of  unsuitable  diet  is  liable  to  continue  and  become 
aggravated.  As  to  a  lessened  use  of  meat,  he  cites  the  dietary  customs 
of  the  inhabitants  of  hot  climates,  who  get  their  proteins  less  from  meat 
than  from  the  leguminosse.  The  appetite  is  lessened  by  long  and  contin- 
ued heat  and  becomes  capricious.  It  craves  variety,  especially  in  vege- 
tables and  fruits,  and  these  he  claims  cannot  be  had  on  the  basis  of  our 
present  ration.  The  need  of  ice  to  furnish  a  cool  drinking  water  and  to 
preserve  the  perishable  constituents  of  the  ration  is  regarded  as  obvious. 

In  a  previous  chapter  (Volume  II,  Chapter  XII)  we  have  discussed 
the  subject  of  diet  in  tropical  countries  and  to  this  the  reader  is  referred. 
From  what  has  been  advanced  in  this  section,  it  will  be  seen  that  the  pro- 
portionate composition  and  fuel  value  of  the  proposed  standard  dietary 
for  troops  serving  in  the  tropics  should  be  about  as  follows: 

Protein    100  grams 

Fats   65       " 

Carbohydrates    .  .    650       " 
Fuel  value 3,491  calories 

This  would  give  a  nitrogen  content  of  16  grams  and  a  nutrient  ratio  of 
protein  energy,  1.8.  The  proximate  alimentary  principles  whose  quan- 
tities and  relative  proportions  are  represented  in  the  above  nutrient  stand- 
ard for  the  tropics  can  be  properly  apportioned  in  the  ideal  ration  for  hot 
climates,  only  as  a  result  of  an  accurate  knowledge  of  the  percentage  com- 
143 


678 


ARMY    AND    NAVY    RATIONS 


position  of  such  articles   of  food    as  may   be  selected   to   enter   into   its 
composition. 

According  to  Munson(6),  the  determination  of  these  foodstuffs  for  the 
American  soldier  is  an  easy  task.  The  present  United  States  army 
ration  is  made  up  of  admirably  selected  articles,  in  more  than  sufficient 
variety.  It  is,  therefore,  not  only  wholly  unnecessary,  but  quite  inadvis- 
able, to  consider  in  this  connection  any  nutritive  substances  outside  those 
articles  legally  established  as  components  of  food  for  the  United  States 
soldier. 

Munson  suggests  the  following  tables  for  tropical  dietaries.  These 
tables  show  the  nutrient  value  of  a  proposed  dietary  for  the  tropics  con- 
taining the  greatest  amount  of  food  material  which  can  be  drawn  by  the 
soldier : 

Table  I 
TROPICAL  DIETARY 


Articles 

Quantity: 
Ounces 

Fats: 
Gra,ms 

Carbo- 
hydrates: 
Grams 

Protein: 
Grams 

Nitrogen: 
Grams 

Fuel 
Value: 
Calories 

Fresh  beef 

10 
18 

2.4 
16 

3 

3.5 

44.75 

5.60 

1.22 

.45 

1.53 

380.46 
40.18 
81.70 
33.80 
94.25 

41.68 

55.08 

15.16 

9.50 

1.77 

6.67 
7.90 
2.42 
1.52 
.27 

590 

Flour 

1,850 
240 

Beans 

Potatoes 

380 

Dried  fruit 

220 

Sugar 

397 

Total 

52.9 

53.55 

630.39 

123.19 

18.78 

3,677 

Total  carbon,  395.14  grams;    nitrogen  to  carbon,  1:19.6. 
The  following  table  shows  a  dietary  proposed  by  Munson,  especially 
applicable  to  tropical  field  service,  in  which  the  fatty  constituents  attain 
their  maximum  and  the  potential  energy  is  high: 


Table  II 
TROPICAL  DIETARY 


Articles 

Quantity: 
Ounces 

Fats: 
Grams 

Carbo- 
hydrates: 
Grams 

Protein: 
Grams 

Nitrogen : 
Grams 

Fuel 
Value: 
Calories 

Bacon 

Hard  bread 

Beans 

6 
18 
2.4 
3 
3.5 

105.06 
6.63 
1.22 
1.53 

371.81 
40.18 
50.70 
94.25 

15.64 

73.12 

15.16 

1.77 

3.49 

11.74 

2.42 

.27 

1,042 

1.926 

240 

Dried  fruit 

220 

Sugar 

397 

Total 

32.9 

114.44 

556.94 

105.69 

16.92 

3,825 

Total  carbon,  328.76  grams;    nitrogen  to  carbon,  1:23. 


U.  S.  ARMY    RATIONS 


679 


The  following  is  an  outline  of  the  ordinary  dietary,  which  Munson 
proposes  for  garrison  duty  in  the  tropics : 


Table  III 
TROPICAL  DIETARY 


Articles 

Quantity: 
Ounces 

Fats: 
Grams 

Carbo- 
hydrates: 
Grams 

Protein: 
Grams 

Nitrogen: 
Grams 

Fuel 
Value: 
Calories 

Fresh  beef 

10 
20 
16 

3 

3.5 

44.75 

6.80 

.72 

1.53 

299.20 
73.09 
50.70 
94.25 

41.68 

53.83 

8.60 

1.77 

6.67 

8.61 

1.40 

.27 

590 

Soft  bread 

1,506 
340 
220 

Potatoes  and  onions . 
Dried  fruit 

Sugar 

397 

Total 

52.5 

53.80 

517.24 

105.88 

16.95 

3,053 

Total  carbon,  328.76  grams;   nitrogen  to  carbon,  1,18. 

In  the  following  dietary  have  been  selected  the  components  most 
closely  approximating  the  character  of  the  foods  usually  consumed  by  the 
natives  of  tropical  countries,  proportioned,  in  the  ternary  food  elements 
common  to  hot  climates: 

Table  IV 

TROPICAL  DIETARY 


Articles 

Quantity : 
Ounces 

Fats: 
Grams 

Carbo- 
hydrates: 
Grams 

Protein: 
Grams 

Nitrogen : 
Grams 

Fuel 
Value: 
Calories 

Fresh  fish  (cod)  whole 
Soft  bread 

14 

20 

4 

16 
3 
3.5 

.79 

6.80 

.45 

.54 
1.53 

299.20 

88.87 

65.80 
50.70 
94.25 

31.73 
53.83 

8.75 

8.17 
1.77 

5.07 
8.61 
1.40 

1.36 

.27 

120 
1,506 

Rice 

407 

Potatoes  and  toma- 
toes  

297 

Dried  fruit 

220 

SuGcar 

341 

Total 

64.5 

10.11 

598.82 

104.25 

16.71 

2.947 

Total  carbon,  327.50  grams;  nitrogen  to  carbon,  1 :19.6. 


The  average  of  the  four  dietaries  in  the  mean  nutrient  composition 
is  outlined  below,  showing  the  composition  and  proportion  of  the  ternary 
food  elements,  the  nitrogen  content  and  fuel  value: 


680 


AKMY   AND    XAVY    RATIOXS 


AVERAGE  NUTRIENT  COMPOSITION 


Dietary 

Quantity: 
Ounces 

Fats: 
Grams 

Carbo- 
hydrates: 
Grams 

Protein: 
Grams 

Nitrogen: 
Grams 

Fuel 
Value: 
Calories 

No.     I 

52.9 
32.9 
52.5 
64.5 

53.55 

114.44 

53.80 

10.11 

630.39 
556.94 
517.24 

598.82 

123.19 
105.69 
105.88 
104.25 

18.78 
16.92 
16.95 
16.71 

3,677 

No.    II 

3,825 

No.  Ill 

3,053 

No.  IV 

2,947 

Average 

50.7 

37.97 

560.85 

109.06 

17.34 

3,375 

Total  carbon,  350  grams;  nitrogen  to  carbon,  1 :20. 

It  will  be  observed,  from  a  careful  study  of  Munson's  tropical  dieta- 
ries, that  while  they  differ  considerably,  yet  on  the  average  they  do  not 
vary  greatly  from  the  nutritive  standard  of  ordinary  tropical  dietaries, 
which  is  an  additional  reason  for  varying  the  articles  of  the  ration  from 
day  to  day.  Even  this  average  dietary,  as  compared  with  nutrient  stand- 
ards, is  still  slightly  deficient  in  fats  and  fuel  value  and  a  trifle  low  in 
protein.  These  defects,  if  they  are  so  considered,  may  be  corrected  by 
rotating  their  order,  so  that  Dietary  II  is  used  twice  where  Dietaries  I, 
III  and  IV  are  each  employed  but  once.  The  results  of  this  change  are 
as  follows : 


Dietary 

Quantity: 
Ounces 

Fats: 
Grams 

Carbo- 
hydrates : 
Grams 

Protein: 
Grams 

Nitrogen: 
Grams 

Fuel 
Value: 
Calories 

No.     I 

52.9 
32.9 
52.5 
64.5 

53.55 

114.44 

53.80 

10.11 

630.39 
556.94 
517.24 
598.92 

123.19 
105.69 
105.88 
104.25 

18.78 
16.92 
16.95 
16.71 

3,677 
3,825 
3,053 
2,947 

No.    II 

No.  Ill -. . . . 

No.  IV 

Average 

47.1 

69.43 

572.06 

108.38 

17.26 

3,465 

Total  carbon,  363.33  grams;  nitrogen  to  carbon,  1:21. 

From  a  study  of  the  above  tables,  it  is  apparent  that  certain  changes 
are  advisable  in  the  adaptation  of  the  United  States  army  ration  to  trop- 
ical conditions.  The  change  could  be  admirably  made  by  reducing  the 
allowance  of  potatoes,  fats  and  bread,  and  substituting  succulent  vege- 
tables and  fruits.  The  sugars  and  starches  might  be  slightly  augmented, 
but  their  increase  is  small  when  compared  with  the  considerable  reduc- 


U.  S.  ARMY   EATIOI^S 


681 


tion  of  nitrogenous  and  fatty  material  which  is  proposed.  Many  of  the 
components  of  the  present  ration,  as  is  seen  by  the  following  table,  require 
no  change  in  the  consideration  of  the  tropical  dietary,  being  not  only 
admirably  selected  but  also  properly  proportioned. 

It  is  true  that  the  needs  of  the  economy,  as  shown  by  appetite,  are 
subject  to  wide  variation.  Hence  it  may  be  accepted  that  slight,  but  care- 
fully considered  changes  in  the  constituents  of  the  daily  dietary,  far  from 
being  detrimental,  are  productive  of  actual  benefit.  It  is  also  obvious 
that  the  soldier  will  require  less  nutriment  in  garrison  than  is  necessary 
to  furnish  the  energy  for  the  greater  labors  of  campaign,  and  hence  the 
several  components  of  the  ration  should  be  proportioned  to  furnish  dieta- 
ries properly  varying  in  potential  and  nitrogenous  value.  This  is  accom- 
plished in  the  foregoing  modifications  of  the  dietaries  shown  in  tables 
ItoIV: 


COMPONENT  PARTS  UNITED  STATES  ARMY  RATION 


Articles 

Quan- 
tity per 
Ration: 
Ounces 

Pro- 
tein: 
Grams 

Nitro- 
gen: 
Grams 

Fats: 
Grams 

Carbo- 
hydrates: 
Grams 

Fuel 
Value: 
Calories 

Fresh  Beef  (quarters) 

10 
10 

6 

6 
10 
10 
14 
18 
20 
18 
20 

2.4 

2.4 

4 

4 
16 

16 

16 
3 
3.5 

Igill 
1    « 

41.68 
46.20 
27.54 
15.64 
40.27 
45.37 
31.73 
55.08 
53.83 
73.12 
50.40 
15.16 
16.38 
8.75 
9.20 
9.50 

8.60 

8.16 
1.77 

6.67 
7.35 
4.40 
2.49 
6.44 
7.26 
5.07 
7.90 
8.61 
11.74 
7.99 
2.42 
2.62 
1.40 
1.47 
1.52 

1.40 

1.30 
.27 

44.75 

62.90 

112.54 

105.06 

64.68 

1.13 

.79 

5.60 

6.80 

6.63 

12.40 

1.22 

.75 

.45 

.67 

.45 

.72 

.58 
1.53 

380.46 

299.20 

371.81 

425.80 

40.18 

41.80 

88.87 

88.75 

81.70 

73.09 

62.59 
33.80 
94.25 
56.05 
56.25 

590 

Or  Fresh  Mutton 

720 

«   Pork 

1,093 
1,042 

688 

"   Bacon 

«   Salt  Beef 

"   Dried  Fish  (cod) 

197 

"   Fresh  Fish,  average  (whole). 
Flour 

120 
1,850 
1,506 

Or  Soft  Bread 

"   Hard  Bread 

1,926 

"   Com  Meal 

1,986 

Beans 

240 

Or  Peas 

246 

«   Rice 

407 

"   Hominy 

430 

Potatoes 

380 

Or  Potatoes  80  per  cent  and 
Onions  20  per  cent 

"   Potatoes  70  per  cent  and 
Canned  Tomatoes  30  per 
cent 

340 

297 

Dried  Fruit  (average) 

220 

Sugar 

397 

Or  Molasses 

269 

"   Cane  Sirup 

269 

Army  Rations  Past  and  Present — In  the  past,  when  army  rations  were 
planned,  it  was  with  a  view  of  keeping  the  soldier  on  the  smallest  amount 


682  AKMY    AND    NAVY    RATIONS 

of  food  with  the  least  expenditure  of  money.  In  fact,  military  author- 
ities of  the  last  century  believed  that  to  keep  a  soldier  up  to  a  proper 
discipline  he  should  be  clothed  roughly,  given  the  simplest  kind  of  over- 
crowded barracks,  and  fed  like  a  hog,  every  modern  improvement  being 
considered  enervating.  Could  any  of  these  dead  officers  see  the  dining 
rooms  of  some  of  our  modern  barracks,  they  would  surely  think  that  tlie 
service  was  going  to  the  dogs.  It  has  been  elsewhere  remarked  that  when 
hardships  slowly  reduce  vitality,  the  man  is  made  less  able  to  exist  under 
more  privation  in  the  field.  When  there  are  no  luxuries  and  everything 
has  to  be  plain  in  order  to  be  durable  and  serviceable,  it  is  utter  nonsense 
to  talk  of  the  enervating  effects  of  luxuries.  The  present  policy  of  improv- 
ing the  soldier's  table  service  certainly  improves  the  ration  on  principles 
known  to  every  physiologist. 

The  smallest  amount  of  food  that  will  keep  a  man  alive  has  been 
approximately  known  for  centuries,  and  though  modern  experiments  make 


Fig.  12. — Component  Parts  of  a  Day's  Ration  of  the  United  States  Soldier,  Which 
Represents  a  Food  or  Fuel  Value  of  4,199  Calories.  (Courtesy  of  the  Ameri- 
can Museum  of  Natural  History,  N.  Y.) 

our  knowledge  vastly  more  detailed,  accurate  and  scientific,  they  have 
added  little  to  the  knowledge  that  a  man  can  subsist  on  one  pound  of 
bread  and  1^  pounds  of  meat  daily  for  quite  a  long  period.  When  we 
come  to  discuss  the  amount  and  kind  of  food  necessary  to  keep  him  in 
health,  we  are  on  debatable  ground.  We  all  know  men  whose  usual  daily 
food  is  even  more  simple  than  the  army  ration,  but  we  know,  also,  that 
there  are  times,  as  during  occasional  visits  from  home,  when  they  eat 
other  things  that  perhaps  restore  the  balance.  Patients  have  often  been 
restored  to  health  by  a  change  of  diet  made  necessary  by  a  recommended 
change  of  scene.  The  soldier's  diet  should  be  such  as  will  maintain  him 
in  the  best  physical  condition  regardless  of  the  varied  circumstances  under 
whicli  he  may  be  compelled  to  live.  There  never  was  economy  in  under- 
feeding soldiers.     In  all  the  wars  of  the  past,  the  number  of  sick  and 


U.  S.  ARMY    RATIONS  683 

those  dead  from  disease  due  to  improper  food  has  been  larger  than  the 
mortality  due  to  the  enemy's  bullets.  Underfeeding  or  improper  feeding 
undoubtedly  leads  to  excessive  use  of  liquor  and  consequent  dissipation, 
which  is  disastrous  to  the  health  and  efficiency  of  the  troops.  My  observa- 
tion^ is  that  many  soldiers  of  the  Civil  War  formed  habits  of  dissipation 
from  which  they  suffered  until  death.  These  bad  habits,  I  am  quite  sure, 
result  only  from  poor  food. 

The  enormpus  number  of  cases  of  rheumatism  in  veterans  occurring 
during  and  after  the  late  war  may  not  be  due  entirely  to  exposures  from 
army  life,  as  popularly  supposed.  These  men  were  hardened  to  exposure, 
and  should  never  have  had  more  rheumatism  than  hunters,  trappers  and 
the  aboriginal  Indians.  The  limited  and  insufficient  ration,  and  the 
absence  of  fresh  articles  of  food,  were,  no  doubt,  etiological  factors  of 
importance.  Indeed,  new  facts  are  continually  being  brought  forward, 
showing  new  relations  between  disease  and  the  habitual  diet  of  a  patient. 
Diet  in  its  relation  to  diseased  states  is  now  an  all  important  item  of 
therapeutics.  It  is  seriously  questioned  whether  the  bare,  unadorned  and 
unvaried  ration,  as  issued,  will  tend  towards  the  maintenance  of  perfect 
health  and  the  greatest  efficiency  in  the  soldier. 

During  our  Civil  War  the  ration  was  largely  increased,  and  among 
other  components  thirty  pounds  of  fresh  potatoes  were  added  to  every  100 
rations  "where  practicable"  to  issue  same.  The  reports  of  general  officers 
during  the  war  indicated  that  with  this  increased  ration  the  men  were 
overfed,  and  the  law  authorizing  the  issue  of  potatoes  was  repealed  in  1864, 
and  the  ration  reduced  practically  to  what  it  was  at  the  commencement  of 
the  war.  In  1890,  one  pound  of  "fresh  vegetables"  was  added  to  the 
ration  by  law.  The  experience  of  the  Spanish  War  indicated  that  the 
regulation  ration,  made  up  of  many  substitutive  equivalents,  was  not  suit- 
able for  the  field,  and  in  1901  it  was  changed,  a  special  ration  being 
prescribed  for  the  field.  Unquestionably  this  special  ration  is  in  excess 
of  requirements,  and  it  is  doubtful  if  sufficient  transportation  can  be  pro- 
vided to  carry  it  in  a  modern  war. 

The  quantity  of  stores  required  for  one  day's  subsistence  of  150,000 
men  in  the  field  is:  hard  bread,  150,000  lbs.;  bacon,  78,750  lbs.;  canned 
beef,  45,000  lbs. ;  sugar,  30,000  lbs. ;  desiccated  vegetables  (potatoes  and 
onions),  11,250  lbs.;  roasted  and  ground  coffee,  12,000  lbs.;  tomatoes, 
15,000  lbs.;  beans,  22,500  lbs.;  jam,  13,125  lbs.;  vinegar,  1,500  gals.; 
salt,  6,000  lbs.;  soap,  6,000  lbs.;  candles,  2,250  lbs.;  pepper,  375  lbs. 


1  G.  A.  Kreider. 


684  AKMY    AND    NAVY    KATIONS 

The  total  net  weight  of  this  amounts  to  405,750  lbs.,  the  gross  weight  to 
520,140.23  lbs.,  and  it  would  form  a  pyramid  30.58  feet  square  at  the 
base  and  43.75  feet  high.  To  transport  the  stores  would  require  approx- 
imately 15  freight  cars  of  40,000  lbs.  capacity,  or  214  army  wagons. 

Practically  all  the  armies  of  the  world,  in  the  past,  have  been  fed  on 
the  same  general  principles.  There  is  little  doubt  that  the  dryness  and 
sameness  of  the  ration  is  a  great  factor  in  the  production  of  the  tendency 
of  drunkenness  proverbial  among  soldiers  and  sailors. 


RATIONS   FOR   BOYS'    MILITARY    TRAINING   CAMPS » 

Statistics  of  normal  food  consumption  in  the  adult  are  readily  avail- 
able, particularly  so  during  the  past  few  decades,  in  which  a  far  reaching 
interest  in  the  problem  of  human  nutrition  has  engrossed  the  attention  of 
physiologists  and  biological  chemists. 

The  rapid  progress  which  has  recently  been  made  in  infant  feeding 
has  thrown  light  upon  the  dietetic  needs  of  the  human  individual  in  early 
life.  In  fact,  pediatric  literature  abounds  in  well  established  facts  per- 
taining to  the  caloric  requirements  of  the  infant ;  but  there  is,  on  the  con- 
trary, a  singular  dearth  of  statistical  information  pertaining  to  the  actual 
food  requirements  and  dietary  habits  of  the  young  adolescent.  In  fact, 
both  the  physiology  and  pathology  of  the  adolescent  period  offer  a  fertile 
field  with  abundant  opportunity  for  research  to  extend  this  knowledge. 

Dubois  has  done  some  splendid  work  in  this  particular  field,  having 
shown  by  calorimetric  experiment  at  the  Russell  Sage  Institute  of  Pathol- 
ogy, that  the  actual  food  requirements  of  young  boys  is  twenty-five  per 
cent  above  that  of  the  adult.  The  pubescent  period  in  both  sexes  is 
marked  by  great  physical  growth  and  development. 

The  alimentation,  at  this  period,  to  meet  the  demands  for  wear  and 
tear,  growth,  and  development,  should  be  very  rich  in  easily  digested 
proteins.  There  is  no  period  in  man's  existence  when  there  is  greater 
need  for  suitable,  wholesome,  nutritious  alimentation — that  which  will 
supply  the  necessary  energy  for  the  daily  wear  and  tear  of  the  body, 
together  with  the  requisite  elements  for  growth  and  development — than 
at  this  period. 

The  adolescent  youth  should  have  a  liberal  allowance  of  whole  wheat 
bread,  fresh  eggs,  wholesome  meat  and  fresh  vegetables,  and  fruits  of  all 


1  Published  by  the  author  in  "Military  Surgeon,"  May,  1917(14). 


KATIONS  FOR  BOYS'  MILITARY   TRAINING  CAMPS    685 

kinds,  provided  he  digests  them  well,  but  highly  spiced  food  should  he 
restricted. 

A  recent  investigation  by  Gephart(7)  affords  an  insight  into  the 
actual  amount  of  nourishment  taken  by  more  than  300  boys  in  one  of 
the  largest  private  boarding  schools  in  the  United  States.  The  total 
animal  supply  for  such  an  institution,  containing  355  boys,  was  computed 
as  follows,  in  metric  tons  (2,200  lbs.)  : 


Protein 


Fat 


Carbohydrate 


Food  supply 
Waste 

Food  fuel .  . 


20.5 
3.8 


16.7 


25.6 
5.4 


20.2 


60.5 
4.2 


56.3 


The  quantity  of  food,  computed  on  the  basis  of  the  individual  meal 
served,  appears  as  follows: 


Pounds 

Grams 

Calories 

Calories 
(per  cent) 

Protein 

0.1107 
0.1332 
0.3717 

50.2 

60.4 

168.8 

206 
562 
692 

141 

Fat 

39 

Carbohydrates 

47 

1,460 

100 

1  Seventy  per  cent  of  this  was  In  animal  protein. 

The  food  was  of  the  best  quality,  and  included  193  separate  varieties^ 
The  cost  per  meal  was  20  cents,  or  13.8  cents  per  thousand  calories. 

This  is  twice  what  the  poor  man  in  New  York  pays  for  his  food.  But 
these  growing  athletic  boys  were  not  satisfied  with  the  conventional  3,000 
calories  per  day.  The  investigator  of  their  dietary  ascertained  that  beside 
the  4,350  calories  which  they  consumed  daily  at  the  table,  they  bought 
650  additional  calories  in  food  at  a  neighboring  store,  the  principal  item 
being  chocolate. 

From  the  tables  in  Volume  II,  Chapter  XII,  we  see  that  a  patient  in 
hospital  requires  a  minimum  of  1,840  calories  if  the  diet  is  to  maintain 
the  metabolic  balance.  If  he  should  not  be  confined  to  bed,  he  will  require 
a  minimum  of  2,168  calories ;  and  these  estimates  do  not  take  into  account 
any  unusual  demands  made  because  of  the  increased  wear  and  tear  caused 
by  the  disease  process.     A  California  farmer's  family  requires  a  daily 


686 


ARMY    AND    NAVY    RATIONS 


ration  yielding  3,515  calories,  while  the  farm  laborer  requires  4,100  cal- 
ories; a  mechanic  3,500  calories;  a  ploughman,  4,000;  a  boy  on  a 
Connecticut  college  football  team  requires  5,740  calories ;  on  the  Harvard 
boat  crew,  4,620  calories;  on  the  Yale  boat  crew,  4,070,  while  a  man 
sawing  wood  needs  5,700  calories.  The  fuel  to  furnish  the  required 
energy  may  be  derived  from  the  consumption  of  proteins,  fats  or 
carbohydrates. 

Lusk(8)  points  to  the  fact  that  5,000  calories  is  the  amount  of 
energy  a  real  live  American  boy  needs.  A  dietary  furnishing  only  2,800 
or  3,000  calories  will  not  sustain  the  growing  youth,'  as  evidenced  by  the 
"ravenous"  appetite  of  boys.  Lack  of  appreciation  of  this  fact  and  fail- 
ure of  providing  for  it  are  the  contributing  causes  of  undernutrition  in 
young  boys. 

The  facts  presented  above,  based  on  a  liberal  series  of  investigations 
and  observations,  rather  than  a  few  sparsely  scattered  data,  deserves  the 
attention  of  all  medical  men,  and,  in  these  days  of  military  preparedness, 
particularly  of  the  army  officer  who  has  charge  of  rationing  boys'  military 
training  camps.  The  author  has  had  some  experience  with  boys  in  camp 
and  realizes  the  necessity  for  a  well-balanced  ration  for  these  youngsters, 
particularly  with  a  liberal  protein  content  which  is  easily  digested  and 
readily  assimilated. 

It  was  the  privilege  of  the  author  to  be  ordered  to  Fort  Terry  in 
August,  1916,  for  service  with  the  Boys'  Military  Training  Camp.  It 
was  part  of  his  duty  to  inspect  daily  the  kitchens  and  the  cooking  and 
serving  of  food  for  the  boys.  He  soon  became  convinced  that  the  officers 
who  planned  the  rations,  while  they  did  remarkably  well  under  the  cir- 
cumstances, were  lacking  in  experience  in  rationing  young  and  growing 
boys.     Herewith  are  produced  the  menus  for  the  first  week  of  the  camp: 

BOYS'  MILITARY  TRAINING  CAMP,  FORT  TERRY,  NEW  YORK 
DIETARY  FOR  WEEK 


Serving 

Grams 

Calories 

Total 
Calories 

Breakfast,  July  7,  1916: 
Com  flakes 

5  tablespoonfuls 

2 

2  slices 

1  large  square 

1  cup 

65 

100 

60 

15 

240  c.c. 

81 
160 
160 
120 

279 

Eggs,  boiled 

Bread 

Butter 

Breakfast  cocoa 1 

Milk  and  sugar J 

SOO 

RATIONS  FOR  BOYS'  MILITARY   TRAINING  CAMPS    687 

BOYS'    MILITARY    TRAINING    CAMP,   FORT    TERRY,   NEW   YORK 
DIETARY   FOR    \YEEK— Continued 


Serving 


Grams 

Calories 

125 

140 

30  c.c. 

25 

92 

111 

150 

145 

60 

160 

15 

120 

240  c.c. 

156 

100 

258 

50 

290 

100 

120 

60 

160 

15 

120 

240  c.c. 

156 

Total 
Calories 


Dinner: 

Roast  beef 

Brown  gravy 

Stewed  peas 

Boiled  new  potatoes 

Bread 

Butter 

Coffee 

Milk  and  sugar 

Supper: 

Fried  bologna 

Fried  potatoes 

Stewed  apples . 

Bread 

Butter 

Coffee 

Milk  and  sugar 


Liberal  helping 

2  tablespoonfuls 

3  heaping  tablespoons 
3  medium-sized 

2  slices 

1  large  square 

1  cup 

Liberal  helping 

((  « 

3  heaping  tablespoons 

2  slices 

1  large  square 

1  cup 


857 


1,204 


Total  Calories  for  Day 2,861 


Breakfast,  July  8: 
Oatmeal  and  milk .  .  . 
Fried  pork  sausage.  . 

Boiled  potatoes 

Bread 

Butter 

Coffee,  tea  and  sugar 

Dinner: 

Pork  and 

Beans 

Pickles 

Catsup 

Stewed  tomatoes .  .  . . 

Vegetable  soup 

Bread 

Butter 

Coffee 

Milk  and  sugar 

Supper: 

Creamed  cheese 

Potato  salad 

Queen  olives 

Stewed  peaches 

Iced  tea 

Bread 

Butter 


3  heaping  tablespoons 
2  links 

1  large 

2  shces 

1  large  square 
1  cup 

1  slice 

4  heaping  tablespoons 


2  heaping  tablespoons 
6  ounces 

2  sUces 

1  large  square 

1  cup 

Liberal  helping 

3  tablespoonfuls 
3  large 

3  tablespoonfuls 

1  glass 

2  slices 

1  large  cube 


100 

201 

70 

328 

150 

145 

60 

160 

15 

120 

240  c.c. 

156 

30 

80 

294 

0 

0 

0 

0 

100 

16 

180  c.c. 

35 

60 

160 

15 

120 

240  c.c. 

156 

80 

364 

100 

123 

30 

60 

100 

228 

240 

40 

60 

160 

15 

120 

1,110 


781 


1,095 


Total  Calories  for  Day. 


2,986 


688 


AEMY    AND    NAVY    RATIONS 


BOYS'    MILITARY    TRAINING    CAMP,   FORT    TERRY,   NEW   YORK 
DIETARY    FOR    \YF.EK— Continued 


Serving 


Grams 

Calories 

100 

56 

100 

160 

60 

160 

15 

120 

240  c.c. 

156 

100 

210 

100 

101 

100 

112 

60 

160 

15 

120 

240  c.c. 

156 

33 

93 

100 

112 

125 

201 

240  c.c. 

100 

60 

180 

15 

120 

Total 
Calories 


Breakfast,  July  9: 

Farina 

Fried  eggs 

Bread 

Butter 

Coffee 1 

Milk  and  sugar J 

Dinner: 

Roast  pork  loin 

Stewed  corn 

Mashed  potatoes 

Bread 

Butter 

Coffee 

Milk  and  sugar 

Supper: 

Cold  sliced  ham 

Potato  salad 

Jelly  fruit,  pure 

Iced  tea  and  sugar 

Bread 

Butter 


Liberal  helping 

Two 

2  slices 

1  large  square 

1  cup 


Liberal  helping 

2  heaping  tablespoons 

2  heaping  tablespoons 

2  slices 

1  large  square 


652 


1  cup 


1  slice  (small) 

2  heaping  tablespoons 
3 

1  glass 

2  sUces 

1  large  square 


859 


806 


Total  Calories  for  Day 2,317 


Breakfast,  July  10: 
Oatmeal  and  milk .  . , 

Pork  sausage 

Bread 

Butter 

Cocoa  and  sugar .  .  .  . 

Dinner: 

Corned  beef 

Cabbage 

Boiled  potatoes 

Bread 

Butter.  . . .-. 

Supper: 
Macaroni  and  cheese 
Stewed  tomatoes .  .  . , 

Assorted  cakes 

Bread 

Butter 

Coffee 

Milk  and  sugar 


3  heaping  tablespoons 
2  lengths 

2  slices 

1  square 
1  cup 

1  large  slice 

3  heaping  tablespoons 

1  medium  size 

2  slices 

1  square 

2  heaping  tablespoons 

2  heaping  tablespoons 

3  cakes 
2  slices 

1  square 

1  cup 


100 

70 

60 

15 

240  c.c. 

50 
100 
150 

60 

15 

140 

70 
150 

60 

15 

240  CO. 


201 
328 
180 
120 
279 


145 

145 
160 
120 


477 
16 
300 
160 
120 

156 


1,088 


560 


1,229 


Total  Calories  for  Day 2,877 


RATIONS   FOR  BOYS'   :\*riLITARY   TRAINING  CAMPS    689 

BOYS'    MILITARY    TRAINING    CAMP,   FORT    TERRY,   NEW   YORK 
DIETARY    FOR    WEEK— Continued 


Serving 


Grams 

Calories 

115 

93 

100 

160 

60 

160 

15 

120 

240  c.c. 

156 

125 

140 

120 

30 

150 

145 

70 

16 

60 

160 

15 

120 

110 

172 

100 

357 

100 

100 

60 

160 

15 

120 

35 

113 

240  c.c. 

80 

Total 
Calories 


Breakfast,  Jul}'  1 1 : 

Corn  flakes  and  milk 

Boiled  eggs 

Bread 

Butter 

Coffee 1 

Milk  and  sugar ) 

Dinner: 

Roast  beef. 

Fresh  stringless  beans 

Boiled  potatoes 

Stewed  tomatoes 

Bread 

Butter 

Tapioca  pudding 

Supper: 

Beef  pot  roast 

Stewed  sweet  corn 

Bread 

Butter 

JeUy 

Iced  tea,  sugar 


4  heaping  tablespoons 

2 

2  slices 

1  square 

1  cup 


Liberal  helping 

u  u 

1  large 

2  heaping  tablespoons 

2  slices 

1  square 

3  heaping  tablespoons 

Large  slice 

1  ear 

2  slices 

1  square 

1  heaping  tablespoon 

1    " 


689 


783 


—  930 


Total  Calories  for  Day 2.402 


Breakfast,  July  12: 

Sliced  orange 

Milk  toast 

Butter 

Cocoa 

Dinner: 

Roast  mutton 

Gravy 

Stewed  peas 

Mashed  potatoes 

Bread 

Butter 

Shipper: 

Frankfurters 

Potato  salad 

Bread 

Butter 

Stewed  apples 

Coffee,  milk  and  sugar 


1  good  sized 

2  slices 

2  squares 
1  cup 

1  large  slice 

2  tablespoonfuls 

3  tablespoonfuls 
2  tablespoonfuls 

2  slices 

1  square 

3  large 

3  tablespoonfuls 

2  slices 

1  square 

3  tablespoonfuls 
1  cup 


250 

96 

180 

240 

30 

240 

240  c.c. 

279 

75 

234 

30  c.c. 

25 

92 

110 

100 

112 

60 

160 

15 

120 

100 

258 

100 

123 

60 

160 

15 

120 

80 

200 

240  c.c. 

156 

855 


761 


897 


Total  Calories  for  Day 2,413 


690 


ARMY   AND    NAVY    RATIONS 


BOYS'   MILITARY   TRAINING   CAMP,   FORT    TERRY,   NEW   YORK 
DIETARY   FOR   WEEK— Continued 


Serving 


Grams 

Calories 

35 

140 

100 

201 

60 

160 

15 

120 

240  c.c. 

156 

30 

80 

294 

240  c.c. 

35 

60 

160 

15 

120 

110 

179 

240  c.c. 

157 

100 

198 

100 

123 

240  c.c. 

80 

30 

60 

60 

160 

15 

120 

85 

308 

Total 
Calories 


Breakfast,  July  13: 

Fried  bacon 

Oatmeal 

Bread 

Butter 

Coffee,  milk  and  sugar 

Dinner: 

Pork  and 

Beans 

Vegetable  soup 

Catsup 

Bread 

Butter 

Rice  pudding 

Milk 

Supper: 

Pink  salmon 

Potato  salad 

Iced  tea 

Queen  olives 

Bread 

Butter 

Fig  newtons 


2  slices 

3  tablespoonfuls 
2  slices 

1  square 
1  cup 


1  slice 

4  heaping  tablespoons 
4  ounces 

2  slices 

1  square 

2  heaping  tablespoons 
1  glass 


2  tablespoonfuls 

3  tablespoonfuls 

1  glass 
3  large 

2  slices 

1  square 

3  cakes 


777 


945 


989 


Total  Calories  for  the  Day 2,711 


The  menus  have  been  anij)lified  by  showing  the  quantity  of  the  serv- 
ings in  grams,  giving  the  fuel  or  energy  value  of  each  article  of  food  in 
calories,  and  the  total  calories  for  each  meal,  and  for  each  day,  averaging 
in  a  week  2,652  calories  a  day.  Students  of  trophodynamics  who  have 
given  much  thought  to  the  dietary  requirements  of  a  young  American  boy 
know  that  the  above  ration  is  lacking  in  fuel  value,  especially  so  when  we 
remember  that  the  boy  requires  one-half  as  much  more  than  a  farmer  at 
his  occupation,  which  is  strenuous. 

Various  authorities  have  estimated  the  protein  requirements  as  rang- 


RATI0:N^S  for  BOYS'  military  training  camps    691 

ing  from  GO  to  150  grams.  Voit's  standard  was  118  grams;  Chittenden 
thinks  60  grams  sufficient;  while  Atwater's  standard  at  moderate  work  is 
125  grams  and  at  severe  work  150  grams.  As  previously  stated,  the  grow- 
ing boy  needs  a  larger  percentage  of  available  protein  in  his  dietary  than 
the  adult.  He  not  only  needs  it  for  the  necessary  wear  and  tear  upon 
the  tissues  the  same  as  the  adult,  but  in  addition  for  growth  and  develop- 
ment. Moreover,  the  satisfaction  of  bodily  needs  does  not  depend  upon 
protein,  but  upon  useful  protein.  A  complete  protein  contains  about 
twenty  amino-acids,  and  while  most  animal  protein  is  complete,  many 
vegetable  proteins  are  not. 

Therefore,  depending  upon  the  variety  of  protein  furnished,  it  will 
appear  that  it  may  become  necessary  to  consume  several  times  the  amount 
of  protein  actually  catabolized  in  order  to  obtain  sufficient  useful  protein. 
Since  we  cannot  consult  a  chemist  daily  with  regard  to  the  amino-acid 
components  of  various  proteins,  we  will  err  on  the  side  of  safety  if  we 
ingest  slightly  more  than  is  absolutely  necessary. 

Careful  experimental  research  has  emphasized  the  fact  that  each  indi- 
vidual needs  a  different  amount  of  food,  according  to  his  structure  and 
surroundings ;  he  requires  protein,  carbohydrates,  fats  and  water  in  addi- 
tion to  mineral  salts.  It  is  absolutely  essential  that  certain  types  of 
proteins,  certain  types  of  fats,  and  certain  salts  be  included  in  the  dietary. 
It  is  recognized  at  the  present  time  that  something  more  is  essential  for 
the  maintenance,  growth,  development,  and  well  being  of  man  than  the 
ternary  food  elements  just  mentioned.  Foods  contain  a  minute  propor- 
tion of  "accessory  substances,"  generically  called  vitamines,  and  when 
these  are  deficient  or  absent  from  the  dietary,  the  immature  body  does 
not  grow,  while  the  mature  body  does  not  maintain  a  normal  healthy  con- 
dition and  manifestations  of  disease  soon  appear. 

Unless  food  contains  sufficient  vitamine  principles,  no  matter  how  well 
balanced  the  ration  may  be  in  the  ternary  food  elements,  nor  how  large 
quantities  are  consumed,  nor  how  high  the  caloric  value  may  be,  there 
will  be  malnutrition.  This  is  frequently  the  case  among  the  poor,  who 
consume  large  quantities  of  food  which  is  neither  proportionately  bal- 
anced nor  sufficiently  varied  to  furnish  the  requisite  vitamine  con- 
tent, and  for  this  reason  diseases  of  malnutrition  are  common  among 
them. 

Below  we  append  a  daily  menu  for  one  week  of  what  we  consider  a 
well  balanced  ration  for  a  growing  boy;  this  ration  will  furnish  about 
125  grams  of  protein  daily  and  an  average  of  about  4,300  calories. 


692 


AEMY    AXD    NAVY    RATIONS 


PROPERLY   BALANCED   DIETARIES   FOR  BOYS'   MILITARY 
TRAINING  CAMPS 

REQUISITE  AMOUNTS  OF  THE  TERNARY  FOOD  ELEMENTS  AND  FUEL 
OR  ENERGY  VALUE  IN  CALORIES 


Serving 


Grams 

Calories 

250 

96 

100 

201 

100 

160 

35 

140 

60 

160 

15 

120 

240  c.c. 

156 

180  c.c. 

243 

100 

343 

80 

128 

100 

112 

200 

10 

31 

136 

60 

160 

15 

120 

155 

338 

240  c.c. 

279 

100 

200 

140 

477 

200 

46 

60 

160 

15 

120 

126 

352 

240  c.c. 

80 

Total 
Calories 


Monday  Breakfast: 

Orange 

Oatmeal,  milk  and  sugar. . .  . 

Eggs 

Fried  bacon 

Bread 

Butter 

Coffee,  milk  and  sugar 

Salt,  pepper 

Dinner: 

Creamed  pea  soup 

Roast  beef 

Brown  gravy 

Lima  beans 

Mashed  potatoes 

Lettuce 

American  cheese 

Bread 

Butter 

Bread  pudding 

Cocoa 

Salt,  pepper,  pickles,  catsup 

Supper: 

Lamb  or  pork  chop 

Macaroni  and  cheese 

Sliced  tomatoes 

Bread 

Butter 

Peach  pie 

Iced  tea 

Salt,  pepper,  pickles,  catsup 


1  medium 

3  tablespoonfuls 

2  boiled 
2  slices 
2     " 

1  square 
1  cup 


6  ounces 

1  slice 

2  heaping  tablespoons 

2        «  « 

}/^  head 

1  ounce 

2  slices 

1  square 

3  heaping  tablespoons 
1  cup 


2  heaping  tablespoons 

1  medium  size 

2  sUces 

1  square 
3^  pie 
1  glass 


1,033 


—       1,863 


Total  Calories  for  the  Day 4,321 


Tuesday  Breakfast: 

Stewed  prunes 

Shreaded  wheat,  milk  and  sugar. 

Scrambled  eggs 

Baked  hash 

Bread 

Butter 

Coffee,  milk  and  sugar 

Salt,  pepper 


6 
1 
2 

2  heaping  tablespoons 
2  slices 
1  square 
1  cup 


120 

1 
312 

69 

205 

100 

160 

100 

140 

60 

160 

15 

120 

240  c.c. 

156 

1,253 


EATIOXS  FOR  BOYS'  MILITARY   TRAILING  CAMPS    693 

REQUISITE    AMOUNTS    OF    THE    TERNARY    FOOD    ELEMENTS    AND 
FUEL  OR  ENERGY  VALUE  IN  CALORIES— Cowimwed 


Dinner: 

Tomato  soup 

Roast  lamb 

Baked  beans 

Baked  potatoes 

American  cheese 

Bread     

Butter 

Indian  meal  pudding 

Cocoa,  milk  and  sugar 

Salt,  pepper,  pickles,  catsup 

Supper: 

Cold  roast  beef 

White  potatoes 

Cucumbers 

Green  corn 

Bread ; .  . . 

Butter 

Sugar  cakes .• 

Lemonade 

Salt,  pepper,  pickles,  catsup 


Serving 


6  ounces 

1  slice 

3  heaping  tablespoons 

1  large 

1  ounce 

2  slices 

1  square 

2  heaping  tablespoons 
1  cup 


1  medium  slice 

3  heaping  tablespoons 

8  thin  slices 

1  ear 

2  slices 

1  square 

3 

1  glass 


Grams 

Calories 

180  c.c. 

186 

100 

200 

115 

152 

150 

160 

31 

136 

60 

160 

15 

120 

164 

324 

240  c.c. 

279 

100 

300 

145 

350 

50 

9 

100 

100 

60 

160 

15 

120 

15 

75 

240  c.c. 

150 

Total 
Calories 


1,817 


1.264 


Total  Calories  for  the  Day 4.334 


Wednesday  Breakfast: 

Cantaloup 

Oatmeal,  milk  and  sugar.. .  . 

Eggs 

Broiled  ham 

Bread 

Butter 

Coffee,  milk  and  sugar 

Salt,  pepper 

Dinner: 

Creamed  corn  soup 

Roast  ham 

Boiled  cabbage 

Lettuce 

Baked  beans,  home  made. . . 

American  cheese 

Creamed  potatoes 

Olives 

Bread 

Butter 

Rice  pudding 

Cocoa,  milk  and  sugar 

Salt,  pepper,  pickles,  catsup 

144 


]/2  medium 
3  tablespoonfuls 
2  soft  boiled 

1  slice 

2  slices 

1  square 
1  cup 


6  ounces 
1  large  slice 
3  heaping  tablespoons 
]/2  head 

3  heaping  tablespoons 

1  ounce 

4  heaping  tablespoons 
3  medium 

2  slices 

1  square 

3  heaping  tablespoons 
1  cup 


465 

93 

100 

201 

100 

160 

35 

140 

60 

160 

15 

120 

240  c.c. 

156 

180  c.c. 

150 

100 

210 

100 

5 

200 

10 

115 

298 

31 

136 

115 

140 

30 

60 

60 

160 

15 

120 

165 

257 

240  c.c. 

279 

—       1.030 


694 


AEMY   AND    NAVY   EATIONS 


REQUISITE    AMOUNTS    OF    THE    TERNARY    FOOD    ELEMENTS    AND 
FUEL  OR  ENERGY  VALUE  IN  CALORIES— Co«tmued 


Serving 


Grams 

Calories 

100 

185 

50 

295 

40 

180 

100 

125 

60 

160 

15 

120 

126 

352 

240  c.c. 

Total 
Calories 


Sup-per: 

Steak 

Potato  chips 

Cream  cheese 

Creamed  onions 

Bread 

Butter 

Apple  pie. 

Water 

Salt,  pepper,  pickles,  catsup 


1  medium  slice 

3  heaping  tablespoons 

2  cubic  inches 

3  small 
2  slices 

1  square 
Kpie 
1  glass 


1,465 


Total  Cajxjries  for  the  Day 4,320 


Thursday  Breakfast: 

Stewed  primes 

Force 

Eggs 

Bacon,  fried 

Bread 

Butter 

Orange  marmalade 

Coffee 

Salt,  pepper 

Dinner: 

Potato  and  meat  soup 

Roast  beef 

String  beans 

Baked  potatoes 

Sliced  tomatoes 

American  cheese 

Bread 

Butter 

Ice  cream 

Chocolate  cake 

Cocoa 

Salt,  pepper,  pickles,  catsup 

Supper: 

Pork  chop 

Macaroni  and  cheese 

Sliced  beets 

Green  com. .  •. 

Sliced  cucumbers 

Bread 

Butter 

Peach  pie 

Salt,  pepper,  pickles,  catsup 


6  medium 

5  heaping  tablespoons 

2  soft  boiled 

2  sUces 

2     « 

1  square 

1  heaping  tablespoon 

1  cup 


6  ounces 

1  sUce 

4  heaping  tablespoons 

1  medium  size 

lux 

1  ounce 

2  slices 

1  square 

2  heaping  tablespoons 
1  medium  shce 

1  cup 


1  chop 

2  heaping  tablespoons 
2        "  " 

1  ear 

8  thin  slices 

2  slices 

1  square 
Kpie 


120 

312 

18 

66 

100 

160 

60 

140 

60 

160 

15 

120 

30 

115 

240  c.c. 

156 

180 

210 

100 

357 

120 

26 

130 

149 

200 

46 

31 

136 

60 

160 

15 

120 

100 

190 

70 

258 

240 

279 

70 

113 

140 

470 

70 

29 

100 

100 

50 

9 

60 

160 

15 

120 

126 

360 

—       1,219 


1,929 


1,361 


Total  Calories  for  the  Day 4,509 


KATIONS  FOR  BOYS'  MILITARY  TRAINING  CAMPS    695 

REQUISITE    AMOUNTS    OF    THE    TERNARY    FOOD    ELEMENTS    AND 
FUEL  OR  ENERGY  VALUE  IN  CAhORlES— Continued 


Friday  Breakfast: 

Peaches 

Oatmeal,  milk  and  sugar.. .  . 

Egg? 

Bread 

Butter 

Toasted  cheese 

Coffee,  milk  and  sugar 

Salt,  pepper 

Dinner: 

Creamed  pea  soup 

Fresh  haddock  or  white  fish. 

Lima  beans 

Creamed  mashed  potatoes . . 

Sliced  tomatoes 

American  cheese 

Bread 

Butter 

Bread  pudding 

Queen  olives 

Cocoa 

Cakes 

Salt,  pepper,  pickles,  catsup 

Supper: 

Vegetable  soup 

Baked  beans 

Cheese  and  macaroni 

Sliced  tomatoes 

Bread 

Butter 

Lemon  pie 

Lemonade 

Salt,  pepper,  pickles,  catsup 


Serving 


1  average  size 

3  heaping  tablespoons 

2  soft  boiled 
2  slices 

1  square 

2  ounces 
1  cup 


6  ounces 
Liberal  helping 

3  heaping  tablespoons 

4  «  u 

1  medium  sized 

1  ounce 

2.  slices 

1  square 

3  heaping  tablespoons 

3  medium  sized 

1  cup 

2 


6  ounces 

4  tablespoonfuls 

3  heaping  tablespoon§ 

1  medium  sized 

2  slices 

1  square 
Kpie 
1  glass 


Grams 


128 
100 
100 

60 

15 

50 
240  c.c. 


180  c.c. 
100 
120 
115 
200 

31 

60 

15 
155 

30 
240  c.c, 

22 


180  c.c. 

200 

140 

200 

60 

15 

110 

250  c.c, 


Calories 


44 
201 
160 
160 
120 
250 
156 


243 
108 
200 
141 

46 
136 
180 
120 
337 

60 
279 

94 


24 
400 
441 

46 
160 
120 
288 
174 


Total 
Calories 


1,091 


1.929 


1,325 


Total  Calories  for  the  Day 4,345 


Sahirday  Breakfast: 
Stewed  prunes. . . 
Shredded  wheat . 

Eggs 

Baked  hash 

Bread 

Butter 

Coffee 

Salt,  pepper 


1.253 


696 


AKMY   AND    NAVY    RATIONS 


REQUISITE    AMOUNTS    OF    THE    TERNARY    FOOD    ELEMENTS    AND 
FUEL  OR  ENERGY  VALUE  IN  CALOmES— Continued 


Serving 


Grams 

Calories 

180 

160 

100 

310 

180 

12 

90 

18 

145 

350 

60 

160 

200 

47 

15 

120 

165 

257 

30 

60 

240  c.c. 

279 

100 

135 

50 

295 

100 

100 

200 

9 

31 

136 

60 

160 

15 

120 

126 

352 

250  c.c. 

150 

Total 
Calories 


Dinner: 

Creamed  com  suet 

Roast  beef 

Cauliflower 

String  beans 

White  potatoes 

Bread 

Sliced  tomatoes 

Butter 

Rice  pudding 

Olives 

Cocoa 

Salt,  pepper,  pickles,  catsup 

Supper: 

Mutton  chop 

Potato  chips 

Green  corn 

Sliced  cucumbers 

American  cheese 

Bread 

Butter 

Peach  pie 

Lemonade 

Salt,  pepper,  pickles,  catsup 


6  ounces 

1  slice 

3  heaping  tablespoons 

3 

3        « 

2  slices 

1  medium  sized 
1  square 

3  heaping  tablespoons 
3  medium 

1  cup 


1  chop 

3  heaping  tablespoons 

1  ear 

8  thin  slices 

1  ounce 

2  slices 

1  square 
J^pie 
1  glass 


—        1,743 


1,564 


Total  Calories  for  the  Day 4.560 


Sunday  Breakfast: 

Cantaloup 

Oatmeal,  milk  and  sugar 

Eggs 

Breakfast  bacon 

Bread 

Currant  jelly 

Butter 

Coffee,  milk  and  sugar.. . 
Salt,  pepper 

Dinner: 

Watermelon 

Bean  soup 

Olives 

Roast  chicken 

Baked  potatoes 

Radishes 

Shced  tomatoes 


J^  medium 

3  heaping  tablespoons 
2  boiled 
2  sUces 
2     " 

1  heaping  tablespoon 
1  square 
1  cup 


1  large  slice 

6  ounces 

3  medium 

Liberal  helping 

1  large 

6 

1  medium  sized 


465 

93 

100 

201 

100 

160 

35 

140 

60 

160 

35 

113 

15 

120 

240  c.c. 

156 

300 

40 

180  c.c. 

70 

30 

60 

100 

273 

150 

160 

50 

8 

200 

46 

1,143 


RATIONS    OF    FOREIGN    ARMIES 


697 


REQUISITE    AMOUNTS    OF    THE    TERNARY    FOOD    ELEMENTS    AND 
FUEL  OR  ENERGY  VALUE   IN  CALORIES— Continued 


Serving 


Grains 

Calories 

92 

110 

50 

160 

15 

120 

155 

337 

100 

189 

240  c.c. 

279 

180  c.c. 

78 

200 

400 

100 

300 

200 

46 

100 

100 

30 

80 

15 

120 

126 

252 

Total 
Calories 


Dinner: — Continued. 

Green  peas 

Bread 

Butter 

Bread  pudding 

Ice  Cream 

Cocoa 

Salt,  pepper,  pickles,  catsup 

Suppei': 

Chicken  soup 

Baked  beans 

Baked  macaroni  and  cheese. 

Sliced  tomatoes 

Green  corn 

Bread 

Butter 

Peach  pie 

Salt,  pepper,  pickles,  catsup 


3  heaping  tablespoons 

2  slices 

1  square 

3  heaping  tablespoons 

1  cup 


6  ounces 

4  heaping  tablespoons 
2 

1  medium  sized 
1  ear 
1  slice 
1  square 
H  pie 


1,852 


1,476 


Total  Calories  for  the  Day 4,471 


RATIONS    OF    FOREIGN   ARMIES 


Colonel  Woodrulf,  writiii«i;  on  this  subject(9),  worked  out  a  table  of 
comparison  of  eight  countries.  He  reduced  all  weights  to  grams ;  the 
amounts  of  the  chemical  constituents  were  calculated,  and  the  results 
tabulated  as  given  below.  Space  will  not  permit  an  accurate  comparison 
of  the  analyses  given  of  the  rations  supplied  to  the  armies  of  the  various 
European  countries,  nor  the  vastly  different  systems  in  vogue  for  supply- 
ing the  food. 

In  European  countries,  fresh  meat  is  expensive ;  therefore,  from  econ- 
omy, the  nitrogen  in  the  ration  is  supplied  principally  in  the  form  of  peas, 
beans,  cheese,  etc.  In  Russia,  the  meat  ration  is  low,  and  the  deficiency 
of  protein  is  made  up  by  free  allowances  of  pulses  and  bread.  The  Amer- 
ican soldier,  from  custom,  requires  the  stimulating  effects  of  an  abundance 
of  good,  wholesome,  fresh  meat,  and  the  United  States  is  the  only  country 
which  furnishes  its  soldiers  with  the  whole  ration.  Other  countries  fur- 
nish part,  and  the  soldier  purchases  an  additional  aliment  from  his  pay 


698 


AEMY    A^B    NAVY    RATIONS 


or  from  allowances  for  this  purpose.  In  England,  bread  and  meat  in 
moderate  quantity  are  supplied,  but  the  soldier  must  pay  for  the  rest  and 
as  much  as  twenty-five  per  cent  of  his  pay  may  be  thus  deducted.  In 
Germany,  he  is  furnished  only  bread  and  must  find  the  rest  of  his  ration, 
but  if  the  portion  is  supplied  officially,  the  cost  up  to  three  and  one- 
quarter  cents  is  charged  against  his  pay ;  anything  over  this  is  paid  by  the 
government. 

COMPARATIVE  TABLES  OF  FOREIGN  ARMY  RATIONS   (Woodruff) 


Nation 

Ration 

Pro- 
teins 

Fats 

Car- 
bohy- 
drates 

Cal- 
ories 

Re- 
marks 

1.  England 

1.  Home 

Gm. 
93 

111 
120 
165 
133 

Gm. 
61 

80 

80 

128 

92 

Gm. 
244 

244 
324 
425 
425 

1,938 

2,175 
2,550 
3,634 
3,204 
175 

2.  Foreign  station  or  under 

canvas  at  home 

3.  March 

(a) 

4.  War:  Maximum 

Minimum 

Sometimes  2  oz.  of  rum . 

(b) 

2.  Spain 

1.  Peace:  Maximum 

Minimum 

2.  War,  on  march  or  in  the 

field:  Maximum 

Minimum 

Sometimes    1.7    oz.    of 
brandy 

147 
120 

131 
113 

87 
62 

94 
55 

588 
500 

522 

485 

3,729 
3,421 

3,327 
2,550 

150 

(c) 
(d) 

3.  Austria 

1.  Peace 

155 
165 

125 
130 

504 
504 

3,865 
3,952 

2.  War 

(e) 

4.  Italy 

1.  Garrison 

111 
115 
125 

130 
133 
143 

600 
600 
600 

4,129 

4,163 

4,307 

250 

2.  Camp 

3.  Marching 

(0 

Usually  wine  added 

5.  Germany 

1.  Small  rations  and  por- 
tions in  garrison  and 
cantonments: 

Maximum 

150 
99 

172 
138 
195 

78 

40 
40 

62 

57 

151 

75 

703 
502 

915 
644 
703 
515 

3,947 

2,827 

4,961 
3,744 
4,786 
3,413 

268 

(g) 

Minimum 

2.  Large  rations  and  por- 
tions on  march  or  in 
maneuvers: 

Maximum 

Minimum 

3.  Field:  Maximum 

Minimum 

Commanding  general  may 
add  3 14  oz.  of  whiskey 

ratio:n^s  of  foreign  armies 


699 


COMPARATIVE  TABLES  OF  FOREIGN  ARMY  RATIO^^S— Continued 


Nation 

Ration 

Pro- 
teins 

Fats 

Car- 
bohy- 
drates 

Cal- 
ories 

Re- 
marks 

6.  United  States  . . 

1.  By  law:  Maximum 

Minimum 

2.  Usually  in  field  (by  law) : 

Maximum 

183 
105 

106 
64 

85 

155 

260 
103 

320 
240 

280 

180 

621 
500 

540 
460 
500 

597 

5,368 
3,712 

5,166 
4,722 
5,000 

4,907 

(h) 

Minimum 

Average 

• 

3.  Food  actually  eaten  in 
cold  climate,  moderate 
work,  including  all  ex- 
tras from  garden  and 
purchases 

7.  France 

War:  Maximum 

Minimum 

Add  2  1-10  oz.  of  brandy 

183 
146 

300 
127 

690 
520 

5,455 

4,015 

184 

1  ^'^ 

8.  Russia 

1.  Peace:  Maximum 

Minimum 

Add  3  oz.  of  wine 

2.  War:  Maximum ....... 

Minimum 

Add  43^  oz.  of  wine 

233 
165 

i74 
149 

114 
65 

'62 
50 

976 
746 

806 
640 

5,884 
4,450 

223 
8,583 
3,307 

362 

I  (i) 

!(k) 

(a)  This  is  starvation  diet,  and  the  extra  food  needed  for  health  is  purchased 
and  charged  against  the  soldier  (about  six  cents  a  day),  increasing,  perhaps  doub- 
ling, the  food  value. 

{b)   Can  be  greatly  changed  to  suit  climate. 

(c)  Sufficient  for  such  a  mild  climate  and  very  moderate  work. 

(d)  Varies  enormously  according  to  class  of  rations  issued.  Very  many 
extra  allowances  of  money  for  food. 

(e)  This  i^  augmented  by  four  cents  a  day  for  vegetables,  etc.  On  the 
march  a.  limited  emergency  ration  is  used.  The  war  ration  is  so  insufficient  that 
commanders  of  arinies  or  smaller'  forces  may  change,  supplement,  or  even 
double  it. 

(/)  Allowances  of  one-fifth  of  a  cent  a  day  for  condiments;  occasional  extra 
money  allowances  for  food.  Excepting  the  protein,  it  is  a  very  liberal  diet  for 
so  mild  a  country. 

(g)  This  is  what  the  government  may  supply.  Usually  the  soldier  feeds 
himself  and  is  given  seven  cents  a  day  or  more  to  reimburse  him  for  the  outlay. 
The  food  eaten  is  more  than  this  deficient  diet  allows. 

(h)  Maximum  due  to  fats  if  all  the  bacon  is  used  and  no  meat.  The  entire 
ration  is  supi)lied  and  intended  to  be  eaten. 


700 


AEMY   AND    NAVY    RATIONS 


(?)  Peace  ration  not  stated.  It  is  purchased  as  needed  and  charged  against 
the  soldier.  War  ration  is  subject  to  great  augmentation  for  increased  work  or 
cold  climate.     The  commanding  officer  may  augment  ration  on  the  march. 

(j)  Also  allowed  money  to  buy  one-half  to  one  and  one-half  ounces  extra 
meat,  and  one  to  one  and  one-half  cents  for  vegetables,  salt,  butter,  lard,  and 
groceries. 

(k)  Extra  meat  and  spirits  may  be  ordered  by  the  commander-in-chief. 

All  foreign  armies  have  a  so-called  emergency  ration,  but,  with  the 
exception  of  England,  it  is  nothing  else  but  a  field  ration  in  a  more  con- 
densed and  portable  form,  consisting  of  hard  bread,  and  preserved  meat 
and  vegetables  in  cans. 

Germany. — "In  Germany,  four  types  of  rations  are  also  provided,  tvfo 
for  peace  time  and  two  for  the  field.     The  large  peace  ration,  such  as 


Fig.  13. — Comparative  Fuel  Value  of  the  Food  Rations  of  the  Soldiers  of  the 
Leading  Armies  of  the  World.  (Courtesy  of  the  American  Museum  of  Natural 
History,  N.  Y.) 

issued  during  maneuvers,  consists  of  Y50  grams  of  bread,  or  500  of  field 
biscuit  or  400  of  egg  biscuit;  250  grams  of  fresh  meat,  with  60  of  kidney 
fat,  or  200  of  smoked  bacon,  or  200  of  canned  meat ;  and  vegetables. 
According  to  Bischoif,  its  composition  is:  Protein,  89.9  grams;  fats,  80.7'; 
carbohydrates,  514.8;  with  fuel  value  of  3,230  calories(13). 

"The  other  peace  ration  is  somewhat  smaller  and,  in  certain  garrisons, 
has  to  be  supplemented  from  the  private  means  of  the  soldier.     The  small 


RATIONS    OF   F0REIG:N^   ARMIES  701 

field  ration  averages  141  grams  of  protein,  51  of  fat,  and  458  of  carbo- 
hydrates, with  fuel  value  of  2,929  calories;  the  large  field  ration,  181 
grams  of  protein,  64  of  fat  and  558  of  carbohydrates,  with  fuel  value  of 
3,625  calories.  The  commissary  furnishes  bread  and  meat,"  most  of  the 
other  articles  being  purchased  out  of  a  daily  allowance  of  4  cents  per 
man." 

The  German  soldier  takes  a  cup  of  black  coffee,  or  coffee  with  milk, 
and  bread  in  the  morning,  dinner  at  noon,  and  a  light  supper  in  the  even- 
ing. During  maneuvers,  or  in  the  field,  he  may  also  receive  one  quart  of 
beer,  one  pint  of  wine,  or  about  three  ounces  of  spirits  (14). 

Russia. — "The  Russian  soldier(4)  in  the  field  receives  2^  ounces  of 
black  bread  (from  unbolted  rye  flour),  14^  ounces  of  fresh  meat  or  11 
of  preserved  or  salt  meat,  9  ounces  of  green  vegetables  or  the  equivalent 
in  compressed  vegetables,  1  to  2  ounces  of  suet  or  butter  for  cooking, 
together  with  4  to  5  ounces  of  grits,  tea,  sugar  and  condiments.  Accord- 
ing to  Bischoff,  its  composition  is:  Protein,  120.7  grams;  fat,  39.2  grams; 
carbohydrates,  628  grams;  with  fuel  value  of  3,147  calories." 

Most  of  the  articles  of  the  ration  (bread  excepted)  are  boiled  together 
in  a  large  wheeled  kettle  and  served  as  soup. 

Japan. — "The  Japanese  ration,  in  the  field,  consists  of: 

Rice,  uncooked 30  ounces 

Or  steamed  and  dried ,. 25        " 

"    fresh  bread 20        " 

"    hard  bread 13 

Meat,  canned 10        " 

Or  fresh  (with  bones) 13        " 

(which  may  be  increased  to  20  if  procurable) 

"   salt,  dry  or  smoked  meat 8  ounces 

"   fish 2 

Vegetables,  dry 8        " 

Or  green 32        " 

Pickles,  sauces  and  condiments 

Tea  and  sugar 

Sake  (beer  made  from  rice) 

"The  Japanese  soldier  does  not  take  readily  to  bread,  either  fresh  or 
hard.  During  the  Russo-Japanese  War,  the  meat  component  was  scant 
and  issued  irregularly ;  rice,  fish  and  vegetables  formed  the  staple  ration. 

"The  Japanese  medical  regulations  provide  that  the  nutritive  value  of 
the  ration  shall  never  fall  below  2,580  calories." 


702 


AKMY   AND    NAVY    KATIONS 


France. — "In  France,  four  types  of  rations  are  provided,  two  for  peace 
(garrison  ration  and  maneuver  ration),  and  two  for  war  (ordinary  and 
large  field  rations). 

"The  components  of  the  garrison  and  field  rations  are  as  follows: 


Articles 


Garrison 
ration 


Ordinary 
field  ration 


Large 
field  ration 


Soft  bread  (brown) 
Soup  bread  (white) 

Fresh  beef 

Rice 

Or  pulses 

Lard 

Or  beef  suet 

Salt 

Sugar 

Coffee 


Kg.  Grams 
0.750 
0.250 
0.320 
0.030 
0.060 
0.030 
0.040 
0.015 
0.021 
0.016 


Kg.  Grams 
0.750 

6.400 
0.060 
0.060 
0.030 
0.040 
0.020 
0.021 
0.016 


Kg.  Grams 
0.750 

6.500 
0.100 
0.100 
0.030 
0.040 
0.020 
0.031 
0.024 


"The  soft  bread  ('pain  de  munition')  is  a  leaven-made  bread  from 
flour  bolted  to  20  per  cent;  it  may  be  replaced  by  pain  hiscuite,  or  by 
hard  bread  and  partly  by  Italian  pastes  and  flours  or  cereals;  the  beef, 
by  any  kind  of  fresh  or  preserved  meat,  fish,  cheese  or  milk;  the  rice  and 
pulses,  by  any  available  dry  or  green  vegetables. 

"In  bivouac,  or  whenever  ordered  by  the  commanding  general  in  the 
field,  a  liquid  ration  is  issued  of  either  wine  (one-half  pint),  beer  (one 
pint),  or  brandy  (two  ounces)." 

The  garrison  ration  contains,  according  to  Rouget  and  Dopter: 

Proteins 125.06  grams,  yielding  513  calories 

Fats 60.46     «  "         562      " 

Carbohydrates 573.52      "  «      2,351       " 

Total 3,426      " 


The  maneuver  ration  contains  less  protein  and  fat,  having  a  fuel  value 
of  3,164  calories. 

The  ordinary  field  ration  contains: 

Proteins 123.60  grams,  yielding    507  calories 

Fats 64.74      «  "  602       « 

Carbohydrates 476.99     "  «       1,956      " 

Total 3,065      « 


KATIONS    OF    FOREIGN    ARMIES  703 

Soup  bread  may  be  added  if  available  (which  is  seldom  the  case), 
increasing  the  total  calories  to  3,687.  The  fuel  value  of  the  large  field 
ration  (without  soup  bread)  is  3,383  calories. 

The  French  soldier  takes  two  meals  a  day,  breakfast  at  10  a.m.  and 
dinner  at  5  p.m.,  besides  black  coffee  at  reveille. 

In  time  of  peace,  the  commissary  department  supplies  only  hard 
bread,  sugar  and  coffee,  as  well  as  wine  and  brandy  when  authorized. 
The  rest  of  the  ration  is  purchased  by  the  company  messes  (ordinaires) 
from  special  money  allowances  (about  10  cents  per  man),  under  the 
supervision  of  a  council  appointed  by  the  commanding  officer  (commis- 
sion des  ordinaires).  Money  allowances  remaining  unexpended,  that  is, 
resulting  from  savings  on  the  ration,  as  well  as  proceeds  from  fines,  sale 
of  wastes,  etc.,  are  used  in  purchasing  such  additional  articles  of  food  as 
are  deemed  desirable. 

In  war,  the  men  carry  two  days'  rations  in  the  haversack;  two  more 
are  carried  in  the  regimental  trains,  and  four  on  the  administrative  trains. 

The  following  three  or  four  pages  are  taken  largely  from  a  report  on 
the  ^'Medico-Military  Aspects  of  the  European  War,"  by  Surgeon  A.  M. 
Fauntleroy  ( 1 1 ) ,  U.  S.  Navy  (Bureau  of  Medicine  and  Surgery,  Navy  De- 
partment, Washington,  D.  C.).^  Surgeon  Fauntleroy  had  an  excellent 
opportunity  to  study  conditions  in  the  French  lines,  many  courtesies  being 
extended  him  in  France  by  Dr.  Joseph  Blake,  formerly  of  the  New  York 
Presbyterian  Hospital,  and  Dr.  Alexis  Carrell,  formerly  of  the 
Rockefeller  Institute,  New  York  City. 

Among  other  conditions,  he  investigated  the  methods  of  cooking  in  the 
trenches.  He  says:  "Each  company  of  about  100  men  has  its  field 
kitchen,  and  each  man  carries  with  him  a  tin  cup,  plate,  knife,  fork  and 
spoon.  For  some  months  after  the  outbreak  of  the  war  the  French  armies 
were  not  supplied  with  regular  field  kitchens,  but  were  dependent  upon 
improvised  means  of  cooking  food."  At  the  present  time,  however,  a 
field  kitchen  of  the  same  type  as  the  English  kitchen  is  in  general  use. 
These  field  kitchens  are  augmented  by  improvised  ovens,  situated  as  close 
to  the  entrance  of  the  hoyau  as  is  compatible  with  military  conditions. 
From  this  situation  food  is  served  hot  to  the  men  in  the  trenches,  and  the 
efficiency  of  the  commissary  department  is  a  large  factor  in  promoting 
general  contentment  throughout  the  French  army. 

The  French  ration  is  an  exceedingly  liberal  one  in  every  way,  and  no 
form  of  wholesome  and  suitable  food  is  denied  the  French  soldier.  Men 
of  all  ranks  and  grades  are  apparently  supremely  content  with  this  branch 

1  Used  by  permission  of  the  Secretary  of  the  Navy. 


704 


AEMY   AND    NAVY    RATIONS 


of  the  service.  Hot  coffee  and  bread  are  served  in  the  early  morning,  and 
hot  coffee  is  also  prepared  in  large  quantities,  and  served  throughout  the 
day.  This  latter  is  encouraged  by  the  officers,  as  it  not  only  guarantees 
the  sterility  of  the  water  thus  boiled,  but  reduces  the  necessity  of  drinking 
unboiled  water. 

The  principal  meal,  dejeuner,  is  served  in  the  middle  of  the  day  and 
every  precaution  is  taken  to  make  it  a  complete  and  satisfactory  repast. 
In  the  late  afternoon,  the  evening  meal  is  prepared,  and  in  general,  while 
a  little  less  substantial  than  the  midday  meal,  it  is  still  quite  sufficient. 
As  is  well  known,  the  Frenchman  has  a  light  breakfast — coffee  and  rolls. 

There  are  three  rations  authorized  in  the  French  army:  The  reserve 
ration,  the  strong  ration,  and  the  normal  ration. 

COMPOSITION  OF  THE  RATION  OF  THE  FRENCH  ARMY 


Articles 


Bread: 

Soft 

Field 

Hard 

Meat: 

Fresh 

Canned  (seasoned) 

Dried  vegetables  or  rice 

Small  store: 

Salt 

Sugar 

Coffee,  roasted,  in  tablets 

Coffee,  roasted,  in  tablets  or  loose .  . . 

Coffee,  green 

Lard  (when  fresh  meat  is  issued) 

Potage  sal6  (when  canned  meat  is  issued) 

Brandy 

To  each  man  in  bivouac  or  when  spe- 
cially ordered: 

Wine 

Beer 

Brandy 

Tobacco: 

"Caporal,"  for  officers 

"Cantine,"  for  enlisted  men 


Reserve 
ration 


0.66  Ibs.i 


.66  lbs. 


.176    lbs. 
.0792     « 


.11    qts. 
.055     " 


.044  lbs. 
.033     " 


Strong 
ration 


1.65 
1.54 
1.32 

1.10 
.66 
.22 

.044 
.0704 


lbs. 


.0528  lbs. 
.0627  " 
.066   " 
.11 


.2641  qts. 
.5282  " 
.055   " 


.033 
.033 


lbs. 


Normal 
ration 


1.65 
1.54 
1.32 


lbs. 


.44 
.132 

.044 
.0462 


.0352  lbs. 
.0418  " 
.066   " 
.11 


.2641  qts. 
.5282  « 
.055   " 


.033 
.033 


lbs. 


1  Six  pieces,  or  crackers. 

2  Twelve  pieces,  or  crackers. 


The  greatest  possible  latitude  is  allowed  in  making  substitutes  with 
supplies  procured  by  exploiting  the  local  resources.     This  authority  is 


EATIOXS    OF   FOREIGN^   ARMIES 


705 


vested  in  all  division  generals  and  subordinate  commanders.  The  sub- 
stitutive articles  and  quantities  of  each  authorized  to  be  issued  in  lieu  of 
a  ration  component  are  given  below; 

AUTHORIZED  SUBSTITUTIVE  EQUIVALENTS 


Strong 
ration 


Normal 
ration 


Substitute  for  one  ration  of  fresh  meat  (beef) 

Veal,  mutton,  pork,  rabbit,  horse,  or  fresh  fish ...... 

Meat  pudding,  eggs,  soft  cheese 

Codfish,  salted 

Bacon 

Smoked  meat,  herring,  salted,  or  salted  sardines . .  . . 

Cheese  (Gruyere,  Holland,  Chester,  Roquefort) . .  . . 

Sausage,  small  and  large,  smoked,  herring,  smoked . . 

Sardines,  in  oil 

Codfish,  dried,  meat  powder 

Cow's  milk 

Substitute  for  one  ration  of  dried  vegetables  or  rice . .  . . 

Potatoes 

Turnips,  carrots,  or  cabbage 

Sauerkraut 

Canned  vegetables 

Wheat  flour 

Italian  pastes  (noodles,  vermiceUi,  etc.) 

Corn  meal 

Cheese,  Gruyere,  or  Holland 

Cheese,  soft 


1. 10  lbs. 

1.10  « 

.825  « 

.66  " 

.66  « 

.55  " 

.55  " 

.44  " 

.33  « 

.275  " 

2^6412  qts. 

.22  lbs. 

1.65  « 

2.2 

1.32  " 

.264  « 

.22  " 

.22  « 

.22  « 

.154  « 

.242  « 


0.88  lbs. 

.88  « 

.66  " 

.55  « 

.55  " 

.44  " 

.44  « 

.33  « 

.22  " 

.22  « 

2.201  qts. 

.132  lbs. 

.99  " 

1.32  « 

.792  « 

.154  « 

.132  « 

.132  « 

.132  " 

.088  « 

.132  « 


The  list  gives  the  substitutes  that  were  in  force  prior  to  the  commence- 
ment of  the  present  war,  and  it  has  been  greatly  augmented  since.  There 
is  practically  no  limit  to  the  articles  that  may  be  substituted  by  higher 
commanders  as  long  as  common  sense  is  displayed  both  in  the  dietetic 
properties  of  the  food  and  the  cost  to  the  Government.  This  matter  is 
regulated  in  orders  issued  by  army  and  corps  commanders.  In  these 
orders  the  prices  of  different  foodstuffs  are  fixed,  and  the  farmer  or  mer- 
chant in  the  theater  of  operations  is  given  the  chance  to  sell  these  supplies 
at  or  below  these  figures ;  otherwise  the  supplies  are  formally  requisitioned 
and  paid  for  at  the  rate  stated  in  the  order. 

The  "extraordinary  supplements  authorized"  can  only  be  authorized 
by  army  and  corps  commanders  or  by  commanders  of  independent  forces. 
In  this  case  the  supplies  must  be  furnished  from  the  chain  of  supplies 
moving  from  the  base  depot  forward,  and  these  are  the  only  commanders 


706  ARMY   AND   NAVY   RATIONS 

who  are  in  a  position  to  make  the  arrangements  to  meet  this  situation. 
The  extraordinary  supplements  are  as  follows: 

EXTRAORDINARY  SUPPLEMENTS  AUTHORIZED 

1.  One  ration  of  wine,  beer,  or  brandy. 

2.  Additional:  One-third  ration  of  bread.    One-fifth  ration  of  meat. 

3.  Increase  of  one-half,  one-third,  one-fourth  of  the  complete  "strong" 

or  "normal"  ration. 

In  the  first  instance,  it  must  he  remembered  that  the  substitutes 
authorized  are  obtained  locally,  and  therefore  no  additional  drain  is  made 
on  the  regular  chain  of  supplies  coming  forward.  Under  "the  automatic 
food  supply"  system  in  the  French  army,  one  day's  complete  food  supply 
for  the  entire  army  goes  forward  daily  from  the  regulating  station  to  the 
railhead,  and  from  that  point  forward  until  it  arrives  at  the  ration  wagon 
of  the  organization.  If  the  organization  has  procured  a  substitute  for 
one  of  the  component  articles  locally,  it  follows  that  it  will  not  need  cer- 
tain articles  carried  by  the  train  and  about  to  be  issued.  It,  therefore, 
does  not  draw  these  supplies.  The  latter  train  has  then  a  surplus,  and) 
when  it  is  subsequently  refilled  at  the  railhead,  it  leaves  undrawn  at  that 
point  a  corresponding  quantity.  Similarly,  the  railroad  train  has  a  sur- 
plus, which  it  carries  back  to  the  regulating  station,  where  the  general 
readjustment  is  made. 

In  addition  to  the  ration,  commanders  of  organizations  and  detach- 
ments are  given  a  daily  allowance  of  twenty  centimes  (four  cents)  per 
day  per  man,  with  which  they  are  authorized  to  purchase  locally  additional 
food  supplies.  This  fund  corresponds  to  the  United  States  army  company 
fund. 

In  times  of  peace,  in  garrison,  the  French  ration  is  largely  commutecj 
at  prices  fixed  by  corps  commanders  and  based  on  the  local  market  prices. 
In  time  of  war  this  system  is  not  used  except  in  the  case  of  very  small 
detachments  (principally  cavalry),  chauffeurs,  and  other  individuals  who 
cannot  be  conveniently  rationed  by  organizations.  In  the  latter  case  the 
commutation  rate  is  fixed  in  army  orders.  In  the  positions  occupied  by 
the  French  army  during  1917  it  has  been  comparatively  easy  to  supply 
the  men  and  animals,  the  utmost  advantage  having  been  taken  of  the  elas- 
ticity allowed  for  substitutions  and  additions  to  the  ration. 

The  entire  French  army  in  the  zone  of  the  armies  had  a  most  trying 
time  during  the  winter,  due  to  cold  and  the  water  in  the  trenches. 
Roughly  speaking,  from  one-third  to  one-half  of  the  time  they  have  been 
in  the  first-line  trenches,  the   remainder  of  the  time  they  have   spent 


EATIONS    OF   FOREIGN   AEMIES  707 

either  in  supporting  trenches  or  in  towns  more  or  less  subjected  to  Ger- 
man artillery  fire.  In  the  first-line  trenches  the  quarters  or  dugout 
shelters  of  the  men  are  heated  with  coke  or  charcoal  fires,  which  give  out 
no  smoke.  Food  is  cooked  in  large  kettles  and  field  kitchens  behind  the 
trenches  and  is  subsequently  taken  out  to  the  front-line  trenches  and  dis- 
tributed. The  men  eat  a  hot,  cooked  meal  at  night  and  save  the  rest  of 
the  food  for  the  next  day's  lunch,  when  it  is  heated  before  eating  over  the 
fires  in  the  dugout  shelters.  Men  and  officers  say  they  have  all  fared  better 
under  these  trying  conditions  than  they  usually  fare  in  barracks  in  peace 
time.  The  result  of  this  good  feeding  is  apparent  in  the  physical  condi- 
tion of  the  men  and  in  the  astonishingly  low  sick  reports.  The  Govern- 
ment and  the  army  commanders  have  realized  the  importance  of  keeping 
the  men  fit  during  all  this  period  of  more  or  less  enforced  stationary  siege 
fighting.  They  have  thoroughly  realized  that  it  is  very  poor  economy  to 
restrict  the  food  when  there  is  no  necessity  for  it,  as  there  may  be  later 
on  if  a  forward  movement  is  undertaken  in  a  country  with  all  the  rail- 
roads destroyed. 

The  reserve  ration  is  the  ration  that  is  carried  on  the  man  or  horse. 
Within  the  last  few  years  an  effort  has  been  made  to  reduce  the  load  car- 
ried by  the  man,  and  a  portion  of  this  reserve  ration  is  now  carried  in  the 
combat  train.  The  reserve  ration  carried  by  divisional  cavalry,  and  that 
carried  by  all  elements  of  a  cavalry  division,  is  one  day's  hard  bread, 
three  days'  coffee  and  sugar,  and  one  day's  canned  meat  and  potage  sale. 
The  total  gross  weight  of  these  components  of  the  reserve  ration  is  2.53 
pounds.  In  addition,  one  day's  brandy  per*  man  is  carried.  The  reserve 
ration  carried  by  all  other  troops  and  elements  of  the  army  is  a  straight 
two  days'  ration,  except  that  only  one  day's  brandy  is  included.  One-half 
of  this  reserve  ration  is  carried  on  the  man,  the  other  half  plus  the  brandy 
is  carried  on  the  baggage  wagon  attached  to  the  combat  train. 

The  reserve  ration  is,  in  general,  only  consumed  when  so  ordered  by 
corps  or  division  commanders,  when  contact  cannot  be  made  with  the 
ration  wagons.  In  rare  cases,  where  there  are  no  other  means  of  feeding 
the  men,  organization  commanders  may,  on  their  own  responsibility, 
authorize  its  consumption.  In  this  latter  case  a  full  written  explanation 
of  the  reason  must  be  submitted. 

The  normal  ration  is  that  prescribed  for  troops  in  time  of  peace  in 
barracks,  or  in  time  of  war  when  comfortably  quartered,  out  of  the  pres- 
ence of  the  enemy. 

The  strong  ration  is  that  usually  supplied  daily  in  the  field  to  French 
troops,  and  it  is  on  the  weight  of  this  ration  that  transportation  allowances 


708  AKMY   AND    NAVY    RATIONS 

are  based.  It  is  realized  by  the  French  that  troops  in  the  field  are  sub- 
jected to  much  more  severe  physical  effort  than  troops  in  garrison.  To 
provide  this  additional  energy',  additional  food  is  given  in  the  shape  of  a 
strong  or  increased  ration.  As  already  explained,  the  strong  ration  is  very 
elastic  and  supple.  Almost  any  condition  can  be  met  without  the  fear 
of  violating  regulations. 

In  principle  the  French  soldier  (not  including  the  cavalryman) 
receives  each  night  from  the  ration  wagon  the  supplies  that  he  is  to  con- 
sume at  his  two  meals  the  following  day.  It  will  be  remembered  that, 
with  the  exception  of  coffee  early  in  the  morning,  Frenchmen  only  eat 
two  meals  per  day,  one  before  noon  and  one  in  tlie  late  afternoon.  These 
supplies  he  carries  in  a  light  canvas  bag  {musette),  swung  with  a  loop 
on  his  right  shoulder.  At  the  same  ame  he  receives  one  day's  ration  of 
fresh  meat,  which  is  issued  him  from  the  voiture  de  viande  (meat  wagon), 
which  is  attached  to  the  combat  train.  One-half  of  this  is  eaten  the  night 
on  which  it  is  issued  and  one-half,  after  cooking,  is  put  in  the  musette  to 
be  eaten  cold  the  next  noon.  We  thus  find  that  every  morning,  upon  leav- 
ing camp  or  bivouac,  the  French  soldier  has  with  him  (independently  of 
the  reserve  ration)  one  day's  supply  of  field  bread,  one-half  day's  supply 
of  fresh  meat  (cooked),  one  day's  supply  of  dried  vegetables  to  be  cooked 
for  the  evening  meal,  one  day's  supply  of  salt,  and  one  day's  coffee  and 
sugar,  with  the  exception  that  some  of  this  coffee  and  sugar  is  used  in  the 
morning.  As  before  explained,  these  supplies  may  be  varied  by  substitu- 
tions and  additional  purchases  made  from  the  four  cents  allowed  to  each 
man  over  and  above  the  ration. 

In  the  cavalry  every  effort  is  made  to  reduce  the  weight  carried  by 
the  horse,  and,  in  consequence,  rations  are  issued  theoretically,  every 
evening  before  supper.  The  evening  meal  and  a  cooked  cold  luncheon 
for  the  next  day  are  prepared  for  the  same  evening.  We  therefore  find 
that  in  the  morning,  upon  leaving  camp,  the  cavalry  has,  in  addition  to 
its  reserve  ration,  only  the  food  necessary  for  one  meal.  Under  this  sys- 
tem it  may  be  readily  seen  that  the  evening  meal  of  the  regular  rations 
(the  strong  ration)  is  dependent  upon  the  ration  wagons  making  contact 
with  the  troops  in  time  for  the  preparation  of  the  meal.  It  will,  of  course, 
be  remembered  that  so  long  as  the  cavalry  is  inactive  it  vsdll  probably  be 
kept  near  a  place  where  rations  can  be  readily  supplied,  and  if  active,  it 
will  be  in  a  better  position  than  other  troops  to  secure  its  supply  locally. 
This  system  of  issuing  rations  is  called  by  the  French  "au  cheval."  Pre- 
viously it  had  been  used  with  all  troops,  and  it  is  still  used  by  such  of  the 


KATIONS    OF    FOREIGN    ARMIES  709 

Freucli  organizations  as  are  equipped  with  rolling  kitchens.  However, 
with  infantry  troops  not  equipped  with  rolling  kitchens,  it  has  heen  found 
not  to  be  practicable,  owing  to  the  delay  of  the  ration  wagons  in  making 
contact  with  the  troops. 

TRAINS.— Each  organization,  including  division  and  corps  headquar- 
ters, has  a  combat  and  a  regimental  train  (field  train).  To  the  corps  are 
also  attached  a  corps  supply  train  and  a  corps  meat  train  (auto  trucks). 
In  addition,  there  is  a  corps  cattle  park. 

The  combat  train  is  divided  into  two  echelons,  called  the  first  and  sec- 
ond, respectively.  For  purposes  of  clearness,  the  combat  train  of  an 
infantry  regiment,  as  laid  down  in  the  French  regulations,  will  be 
explained.  The  same  principles  apply  to  the  other  combat  trains,  though 
they  differ  considerably  in  details  in  the  different  armies.  The  strength 
of  an  infantry  regiment  is  3,000  men,  and  this  strength  is  maintained  by 
reserves  sent  forward  to  replace  all  losses. 

The  first  echelon  remains  with  or  in  the  immediate  rear  of  the  organ- 
ization to  which  it  belongs  when  on  the  march  or  during  combat.  It 
includes  one-horse  sanitary  carts  carrying  equipment  for  first-aid  stations, 
two-horse  carts  for  ammunition  for  companies,  four-horse  wagons  or 
caissons  for  machine-gun  ammunition,  and  two-horse  carts  carrying 
entrenching  and  other  tools. 

The  second  echelon,  while  on  the  march  out  of  the  presence  of  the 
enemy,  usually  accompanies  the  first  echelon.  When  contact  with  the 
enemy  is  expected,  it  is  detached  and  grouped  with  other  second  echelon 
combat  trains,  either  in  brigade  or  division  groups,  depending  upon  the 
orders  issued.  During  this  period  of  grouping,  its  movements  are  con- 
trolled by  the  headquarters  ordering  the  grouping.  The  grouped  second 
echelons  are  usually  held  well  in  the  rear  under  cover  and  "out  of  the 
road."  This  echelon  includes  two-horse  wagons  (on  these  wagons  are 
also  carried  a  portion  of  the  reserve  rations  previously  referred  to),  a 
two-horse  forage  wagon,  and  three  two-horse  meat  wagons  (one  per  bat- 
talion). In  addition,  the  regulations  provide  that  the  two-horse  rolling 
kitchen  (when  organizations  are  equipped  with  the  same)  will  form  part 
of  the  second  echelon  of  the  combat  train. 

The  regimental  train  (train  regimentaire)  corresponds  exactly  to  the 
ration  section  of  the  field  train  of  the  United  States  army.  All  field 
units,  including  the  different  headquarters  and  trains,  with  the  exception 
of  the  corps  supply  train,  have  a  regimental  train.     The  regimental  trains 

145 


710  AKMY   A:N^D    NAVY    KATIONS 

of  all  units,  except  that  of  the  cavalry  division,  carry  the  following  sup- 
plies (on  the  basis  of  the  strong  ration)  : 

Bread  (generally  field  bread) 2  days 

Salt 2     « 

Lard 2     « 

Rice  or  dried  vegetables  (1  day  of  each) 2     " 

Canned  meat  vnth'potdge  sale 1  day 

Coffee  (1  day's  supply  is  on  the  basis  of  the  reserve 

ration) 2  days 

Sugar  (1  day's  supply  is  on  the  basis  of  the  reserve 

ration) 2     " 

Brandy 1  day 

Oats 2  days 

The  regimental  trains  of  the  cavalry  divisions  carry  the  following 
supplies  (on  the  basis  of  the  strong  ration)  : 

Field  bread 1  day 

Salt 1     « 

Canned  meat  with  potage  sat4 1     " 

Coffee  (on  the  basis  of  the  reserve  ration) 1     " 

Sugar  (on  the  basis  of  the  reserve  ration) ........  1     " 

Brandy 1     « 

Oats 1     " 

The  foregoing  figures  are  based  on  the  load  at  the  time  the  troops  start 
out,  which,  of  course,  changes  as  soon  as  issues  begin.  It  is  not  safe, 
therefore,  to  count  on  having  on  hand  more  than  one  day's  supply. 

The  regimental  trains  of  all  units  are  usually  kept  grouped  at  all 
times  when  the  troops  are  on  field  service.  This  grouping  is  almost 
invariably  by  divisions,  the  group  being  under  the  orders  of  a  single  offi- 
cer, who  moves  the  grouped  trains  in  accordance  with  orders  received  from 
division  headquarters.  When  the  troops  have  halted,  orders  are  issued 
from  division  headquarters  to  send  forward  one  day's  supply  of  food,  and 
men  from  the  different  organizations  go  to  the  grouped  trains  and  conduct 
the  loaded  vehicles  to  the  troops.  The  issues  are  made,  and  the  empty 
vehicles  are  at  once  sent  back  and  grouped  again.  If  any  supplies  are 
obtainable  locally,  and  their  substitution  is  desired  by  the  troops  in  place 
of  what  is  carried  in  the  wagons,  the  substitution  is  made,  and  the  corre- 
sponding ration  articles  remain  unissued  in  the  wagon. 

From  time  to  time  the  division  headquarters  is  notified  of  the  point 
selected  as  the  "distributing  point,"  and  it  in  turn  notifies  the  officer  in 
command  of  the  grouped  train,  who  sends  the  empty  wagons  to  that  point 
at  the  hour  fixed  for  reloading.  As  soon  as  they  are  reloaded  they  rejoin 
the  grouped  train. 


RATIONS    OF    FOREIGN   ARMIES  711 

MEAT  SUPPLY.— The  system  of  fresli-meat  supply  in  the  French  army 
has  been  materially  changed  in  recent  years.  Formerly  each  division  had 
a  cattle  park,  where  the  cattle  were  butchered  and  from  which  the  dressed 
meat  was  sent  forward  in  wagons,  their  loads  being  transferred  to  the 
meat  wagons  of  the  second  echelon  of  the  combat  train.  This  was  found 
to  be  very  cumbersome.  To-day  the  division  cattle  park  has  been  sup- 
pressed and  replaced  by  the  corps  cattle  park,  where  the  slaughtering  is 
now  done.  The  fresh  meat  is  loaded  in  the  army  corps  meat  train,  which 
is  pushed  forward  close  to  the  point  where  the  gi'ouped  second  echelon 
of  the  combat  train  is  halted,  and  the  organization  meat  wagons  are  filled 
at  these  places. 

The  meat  supply  of  the  French  soldier  has  always  been  a  most  difficult 
question,  because  of  the  national  prejudice  in  France  against  refrigerated 
meat.  This  prejudice  is  somewhat  on  the  wane  to-day,  owing  to  a  lack  of 
cattle  in  France,  and  a  great  quantity  of  Argentine  beef  is  now  being 
received.  There  is  some  trouble  in  handling  this  beef,  due  to  the  fact  that 
refrigerator  railroad  cars  are  hardly  known  in  France,  and  to  the  further 
fact  that  there  are  not  many  cold-storage  plants  for  the  reception  of  the 
meat.  Of  course,  most  of  the  big  cities  have  these  plants,  but  none  are 
found  in  the  small  towns  as  in  America.  To-day  an  effort  is  being  made 
to  use  the  refrigerated  meat  in  the  zone  of  the  interior  and  as  far  as  pos- 
sible to  reserve  the  live  cattle  for  use  in  the  zone  of  the  armies.  The 
Frenchman  does  not  like  our  cured  bacon  nor  does  he  like  canned  meats. 
His  wants,  therefore,  so  far  as  meat  is  concerned,  are  much  more  difficult 
to  satisfy  than  is  the  case  with  our  troops. 

With  a  view  to  the  simplification  of  the  entire  fresh-meat  supply,  a 
number  of  different  methods  have  been  and  are  being  tried  in  France. 
One  method  by  which  the  fresh  meat  was  thoroughly  salted  {viande  demi- 
saU)  was  tried  out,  but  has  been  practically  abandoned  to-day.  This  sys- 
tem had  the  advantage  that  the  meat  could  be  slaughtered  and  treated 
well  to  the  rear,  even  back  of  the  zone  of  the  interior,  and  could  be  sent 
forward  in  the  regular  trains  through  the  regulating  station.  If  success- 
ful, it  would  have  done  away  with  the  corps  cattle  park  and  the  corps 
meat  train.  The  disadvantage  was  due  to  the  fact  that,  while  the  center 
of  the  meat  so  treated  was  perfectly  good,  the  exterior  surface  became 
discolored  and  somewhat  decayed  and  smelly. 

To-day  a  new  scheme  is  being  tried  by  which  the  fresh  meat  is  first 
cooked  and  boned,  then  wrapped  in  cheesecloth,  and  the  moisture  pressed 
out.  If  this  is  successful,  it  will  greatly  simplify  the  problem  of  meat 
supply,  particularly  if  the  war  lasts  long,  and  if  refrigerated  beef  has  to 


712  ARMY    AND    NAVY    RATIONS 

be  resorted  to  entirely.  If,  after  cooking  and  treatment  in  the  manner 
indicated,  meat  will  keep  for  five  or  six  days,  the  plan  will  be  successful. 

The  autotruck  made  it  possible  for  the  French  to  do  away  with  the 
division  cattle  park  and  to  do  their  slaughtering  at  the  corps  cattle  park, 
well  in  the  rear.  All  the  autobuses  in  Paris  were  requisitioned  for  deliv- 
ery purposes,  and  these  are  to-day  distributed  between  the  different  army 
corps,  forming  the  corps  meat  trains.  These  autobuses  have  somewhat  the 
appearance  of  one  of  our  street  cars  in  America,  having  a  platform  on  the 
rear  and  windows  on  either  side.  The  glass  in  the  windows  has  been 
removed  and  replaced  by  fly  screens  with  cotton  bunting  behind  to  keep 
out  the  dust.  The  meat  is  suspended  from  hooks  placed  on  the  rods  run- 
ning along  the  ceiling  of  the  car,  which  previously  furnished  the  supports 
for  the  hand  straps.  Each  autobus  will  carry  approximately  4,000  pounds 
of  beef.  Approximately  fifteen  of  these  autobuses  are  assigned  to  each 
corps.  The  maximum  distance  to  the  front  which  they  are  able  to  supply 
is  seventy-five  kilometers.  It,  therefore,  follows  that  the  corps  cattle 
park  can  be  no  further  than  this  to  the  rear. 

Corps  cattle  parks  are  usually  situated  near  the  railroad,  where  cattle 
on  the  hoof  are  delivered  by  train.  Their  equipment  is  the  simplest  pos- 
sible, notwithstanding  the  fact  that  the  daily  requirements  of  a  corps 
necessitate  the  slaugliter  of  from  100  to  120  head  of  cattle  a  day.  Usually 
barns  and  stables  are  used  for  this  purpose.  The  equipment  in  general 
consists  of  large  wooden  tripods  or  derricks,  about  eight  feet  high.  After 
the  animal  has  been  hit  on  the  head,  he  is  pulled  up  by  the  hind  legs,  the 
throat  arteries  are  cut,  and  the  meat  is  dressed.  The  hides  are  all  most 
carefully  saved  and  shipped  back  to  the  rear.  The  meat  when  cut  up  is 
at  once  loaded  into  the  autobus,  where  it  cools.  A  veterinary  surgeon  is 
always  present  during  the  slaughtering  to  pass  on  the  quality  of  the  meat. 

Slaughtering  is  usually  done  in  the  late  afternoon,  the  autobuses  or 
corps  meat  train  being  sent  forward  the  following  morning  to  make  con- 
tact with  the  organization  meat  wagons  (attached  to  the  second  echelon 
of  the  combat  train).  The  meat  is  then  transferred,  and  the  autobuses 
return  to  receive  their  new  loads  during  the  slaughtering  in  the  afternoon. 
Effort  is  always  made  to  counteract,  so  far  as  possible,  the  slowness  in 
movement  of  beef  on  the  hoof  (about  four  kilometers  an  hour).  As  has 
been  shown,  the  park  with  the  meat  train  can  be  operated  seventy-five 
kilometers  behind  the  troops.  This  is  about  three  days'  march  under  the 
most  favorable  conditions  for  tlie  troops.  When  a  rapid  advance  is  under- 
taken a  portion  of  the  personnel  of  the  cattle  park  is  sent  forward  to  a 
point  farther  advanced,  and  cattle  are  shipped  in  and  held  in  anticipation 


RATIONS    OF   FOREIGN   ARMIES  713 

of  the  arrival  of  the  remainder  of  the  personnel.  When  all  the  cattle  have 
been  slaughtered  at  the  first  place,  the  tools  and  equipment  are  loaded  in 
an  autotruck  and  sent  forward  to  the  new  position.  Thus,  within  a  few 
hours  the  park  can  be  advanced,  if  necessary,  three  days'  march.  The 
corps  meat  train  is  the  only  corps  train  to  which  autotrucks  are  regularly 
assigned.  The  autotruck  in  this  case  is  a  "transportation  unit"  pure  and 
simple  and  does  not  provide  the  means  for  transporting  a  "rolling 
reserve."  The  rolling  reserve  of  meat  is  carried  in  the  corps  supply  train. 
The  corps  supply  train  carries  two  days'  strong  ration  and  two  days' 
oats.     The  load  consists  of  the  following  supplies : 

Salt 2  days 

Dried  vegetables 1  day 

Rice , 1     « 

Sugar  (1  day's  strong  and  1  day's  reserve  ration) . .  2  days 

Coffee  (1  day's  strong  and  1  day's  reserve  ration) . .  2      " 

FIGURES  UPON  WHICH  ALLOWANCES   OF   TRANSPORTATION  FOR 

RATIONS    ARE    BASED 

The  net  weight  of  the  reserve  ration,  not  including  brandy,  is  1.6852  pounds. 
The  net  weight  of  the  strong  ration,  with  field  bread,  canned  meat,  potage  sale, 

and  not  including  spirits,  is  2.6972  pounds. 
The  net  weight  of  the  strong  ration  without  meat  and  spirits,  and  including  lard, 

is  1.9932  pounds. 

Great  Britain. — "The  ration  of  the  British  soldier,  in  garrison,  consists 
of  10  ounces  of  bread,  12  ounces  of  meat,  and  such  additional  articles 
(vegetables,  groceries)  as  are  purchased  out  of  a  daily  allowance  of  seven 
cents.    During  maneuvers  the  meat  is  increased  to  16  ounces. 

"In.  the  field,  his  ration  varies  according  to  climate  and  the  character 
of  his  work;  it  generally  consists  of  IG  ounces  of  salted  or  preserved  meat, 
or  16  to  20  ounces  of  fresh  meat;  20  ounces  of  fresh  bread  or  16  ounces 
of  hard  bread  or  flour;  1  ounce  of  compressed  vegetables,  or  8  ounces  of 
potatoes  (or  other  fresh  vegetables),  or  2  ounces  of  rice  (or  split  peas), 
or  4  ounces  of  onions ;  coifee,  tea  or  chocolate,  sugar  and  the  usual  condi- 
ments.    Two  ounces  of  spirits  and  some  tobacco  may  also  be  allowed"  (4). 

An  emergency  ration  is  provided  in  the  British  army,  for  use  only 
when  no  other  food  is  procurable  and  when  authorized  by  the  command- 
ing officer.  It  is  contained  in  a  flat  can  and  consists  of  chocolate,  sugar 
and  protein  in  the  form  of  "plasmon,"  weighing  6^  ounces  net.  Accord- 
ing to  Langworthy,  its  proximate  principles  average:  protein  59  grams, 
fat  50  grams,  and  carbohydrates  65  grams,  with  fuel  value  of  973  cal- 


714  ARMY   AND    NAVY   RATIONS 

ories.     This  ration,  like  the  United  States  emergency  ration,  is  relatively 
too  rich  in  protein  and  deficient  in  carbohydrates. 

According  to  the  "Times  History  of  the  War,"  the  ration  of  the  Eng- 
lish soldier  at  the  beginning  of  the  present  war  was: 

1}4  pounds  biscuit 

1      pound  fresh  meat  or  1  pound  tinned  meat 

4      ounces  jam 

3      ounces  sugar 

3      ounces  desiccated  vegetables 

}4  ounce  tea 

}4  ounce  coffee 

14  ounce  pepper 

yi  ounce  salt 

At  the  outbreak  of  the  war,  the  ration  was  increased  by  an  addition  of 
good  bacon,  4  ounces,  and  cheese,  3  ounces ;  six  months  later,  tlie  meat* 
ration  was  increased  to  1^  pounds  of  fresh  meat  and  a  more  liberal  allow- 
ance of  tea  was  permitted ;  occasionally,  ^  of  a  tin  of  condensed  milk  is 
given  in  place  of  the  extra  ^  pound  of  meat. 

Systems  of  Supply. — In  France,  the  bread  and  a  trifle  of  sugar  and 
coffee  are  supplied  in  kind,  the  rest  being  supplied  by  the  war  depart- 
ment, and  gardens  are  an  essential  part  of  the  scheme.  In  Italy  the  food 
is  supplied  on  the  same  basis  as  the  clothing  allowance  in  the  United 
States  army — that  is,  so  much  money  per  day  is  allotted  to  each  soldier, 
and  if  he  is  supplied  in  kind,  so  much  money  is  deducted  from  his 
account.  In  Austria  only,  bread  is  supplied  in  times  of  peace,  and  a  daily 
allowance  of  money  given  to  purchase  the  rest,  somewhat  as  in  France. 
In  Russia,  bread  and  meat  are  supplied  in  kind,  but  a  money  allowance 
is  given  for  other  things  and  for  extra  meat.  In  Spain,  bread  only  is 
supplied,  as  in  Germany,  and  the  rest  is  charged  up  against  the  soldier's 
pay,  as  in  England.  These  systems  are  all  very  well  in  countries  where 
the  soldiers  live  in  thickly  settled  districts,  where  they  have  opportunities 
to  buy  such  things  as  they  want,  but  would  be  totally  unsuitable  for  the 
frontier  in  our  country ;  hence,  the  United  States  is  the  only  nation  com- 
pelled to  supply  the  soldier's  whole  food. 

At  the  commencement  of  the  United  States  Civil  War  the  supplies 
to  be  carried  by  the  troops  were  prescribed  in  General  Orders,  which  pro- 
vided that  in  ordinary  marches,  where  the  men  could  receive  daily  issues 
from  the  trains,  they  should  carry  only  two  days'  rations;  but  in  the 
immediate  vicinity  of  the  enemy,  and  where  the  exigencies  of  the  service 
rendered  it  necessary  to  move  without  baggage  or  trains,  they  were 
required  to  carry  from  eight  to  twelve  days'  rations.     In  the  Spanish- 


JiATIOXS    OF    FOKEIGX    ARMIES 


715 


American  War,  the  General  Orders  did  not  prescribe  the  number  of  days' 
rations  to  be  carried  by  the  men. 

In  the  German  army,  foot  troops,  horse  and  field  artillery,  and  train, 
carry  three  days'  "iron"  rations,  the  cavalry  one  day's.  The  German 
''iron  ration"  consists  of  hard  bread,  9  ounces ;  preserved  meat  or  bacon, 
7  ounces ;  vegetables,  3^  ounces ;  coffee,  ^  ounce.  Total  weight,  including 
packing,  1  pound,  10  ounces;  three  days'  rations,  4  pounds,  14  ounces. 

In  the  French  army  the  cavalry  carry  one  day's  bread,  preserved  meat 
and  groceries,  and  all  other  troops  two  days'.  This  ration  consists  of 
bread,  about  33  ounces ;  preserved  meat,  about  9  ounces ;  groceries,  about 
5^  ounces.     Total  weight,  47^  ounces,  or  about  3  pounds. 

In  the  Russian  army  the  infantry  carry  2^  days'  hard  bread  in  their 
haversack ;  the  cavalry  and  horse  artillery,  1^  days' ;  field  artillery  and 
sappers,  3  days'.  The  hard  bread  ration  consists  of  1  pound  13  ounces; 
2^  days',  therefore,  would  be  about  4^  pounds. 

The  United  States  Field  Service  Regulations  provide  for  the  min- 
imum to  be  carried  on  the  man  or  horse — 1  emergency  ration  and  1  field 
ration.  Weight:  1  field  ration,  2.92  pounds  net,  3.64  pounds  gross; 
1  emergency  ration,  1  pound  net,  1.25  pounds  gross;  total,  4.89  pounds 
gross,  or  nearly  5  pounds. 

COMPARATIVE  RATIONS  OF  THE  ARMIES  OF  THE  WORLD 

Below  are  given  the  rations  of  the  soldiers  of  the  leading  armies  of 
the  world,  both  in  times  of  peace  and  war.  According  to  Colonel  Wood- 
ruff, when  these  are  compared  with  the  ration  of  the  soldier  in  the  United 
States  array,  it  will  be  seen  that  our  men  are  better  fed  than  men  in  any 
other  army  of  the  world : 

COMPARATIVE  RATIONS  OF  THE  LEADING  ARMIES  OF  THE  WORLD 

DAILY  RATION   OF  THE   AUSTRIAN   SOLDIER 


Peace 

Meat 

Bread 

Or  biscuit 

Flour 

Or  groats  or  barley 
Or  potatoes 

Rice 

Sauerkraut 

Butter  or  fat 


Ounces 


6 

30 

17 

6 

6 

20 
3 
5 


War 

Meat 

Or  salt  meat  or  bacon 

Biscuit 

Flour 

Vegetables 

Potatoes 

Peas  or  beans 

Or  potatoes 

Butter  or  fat , 

Sugar 

Coffee 


Ounces 


9H 
6 

26M 
5 
9 

U 

H 
H 


716  AEMY   AND    N^AVY    KATIONS 

COMPARATIVE    RATIONS    OF    THE    LEADING    ARMIES    OF    THE 

WORLD— Continued 

DAILY   RATION   OF   THE    ENGLISH   SOLDIER 


Peace 


Meat,  fish,  bacon,  or  liver. 

Bread 

Vegetables 

Potatoes 

Milk 

Sugar 

Butter 

Peas   or   beans,    in   lieu   of 

vegetables 

Lime-juice 

Salt,  3^;  tea,  }4  or  coffee.  . . 


Ounces 


12 
16 

4 
12 

5 

2 

1 

I'A 
1 


War 


Meat,  fresh 

Or  preserved 

Bread 

Or  biscuits 

Vegetables,  fresh 

Or  compressed 

Peas    or    beans  in  lieu   of 

vegetables 

Sugar 

Cheese 

Tea,  J^;  coffee  or  cocoa.  . . 
Pickles,  occasionally 
Rum,  when  necessary 


Ounces 


16  or  20 
20 
20 
16 
16 
1 

3 

3 

2  to  3 


DAILY   RATION   OF   THE    FRENCH   SOLDIER 


Peace 

Ounces 

War 

Ounces 

Meat 

lOJ^ 
26  M 
21 
3^ 

Meat 

14^ 
26  M 
21 

Bread 

Bread ". 

Or  biscuits 

Or  biscuits 

Vegetables,  fresh 

Vegetables,  compressed 

Butter 

1 

Butter 

1 

Other  articles  are  paid  for 

Rice 

by  men  out  of  their  allow- 

Sugar  

ance.  Laveran  estimates  that 

Soup, condensed 

M     ■ 

the    ordinary    peace    ration 
contains  124  grams   protein 
and  764  grams  carbohydrate. 

DAILY  RATION  OF  THE   GERMAN   SOLDIER 


Peace 

Garrison 
Ounces 

Field 
Ounces 

War 

Ounces 

Meat 

5^ 
4^ 

26  >^ 

53 
4M 
3K 

1714 
6 
351^ 
71 

m 

Meat 

13  W 

Or  bacon.. . . 

Or  sausage 

8H 

Bread 

Or  potatoes^ 

Bread 

Or  potatoes 

263^ 
52 

Oatmeal 

Vegetables 

6 

Rice 

Rice  or  ground  barley 

Coffee 

4M 
1 

Coffee 

Butter 

Brandy 

SH 

Or  wine 

1714 

Or  beer  

35 

1  In  lieu  of  potatoes,  12  ounces  of  peas  or  beans. 


RATIONS    OF    FOREIGN    ARMIES  717 

COMPARATIVE    RATIONS    OF    THE    LEADING    ARMIES    OF    THE 

WORLD — Continued 

ITALIAN   RATION 


Peace 


Meat . .  . . 

Bread,   flour,   or   biscuit 

Bacon 

Rice 

Sugar 

Coffee 

Wine' 


Ounces 


7  to  11 

'A 


War 


RATION   OF  THE  JAPANESE   SOLDIER 


Peace 

Ounces 

War 

Ounces 

Rice 

36 

Meat  (periodically) 

Fresh  fruit 

16 

Money  allowed  for  other 

20 

necessaries. 

Rice  (daily) 

36 

Vegetables 

4 

Bean  sauce 

2 

Pickles  or  fruit 

2 

Sugar 

14 

Tea 

^ 

Japanese  cake 

8 

Sake  (spirit) 

6K 

Cigarettes 

20 

DAILY   RATION   OF  THE   RUSSIAN   SOLDIER 


Peace 


Meat 

Flour   or   biscuit 

Groats 

Or  peas  or  beans. .  . . 

Or  potatoes 

Or  turnips  or  carrots 
Or  cabbage 


Ounces 


7H 
26 

4 

14^ 
27  M 
35 
50 


War 


Meat 

Or  ham 

Flour 

Sugar 

Tea 

Butter 

Peas  or  beans 

Groats 

Variable    as     in     peace 
ration. 


Ounces 


7M 
S'A 
29 

u 


5 

4M 


1  See  footnote,  page  683.  We  do  not  think  it  wise  to  allow  whiskey,  beer,  wine  or 
brandy  as  a  component  of  the  soldier's  ration.  Certainly  no  man  having  indulged  in 
alcoholic  drinks  should  be  permitted  to  engage  in  the  work  of  aviation,  nor  allowed  to 
paVticipate  in  the  handling  of  large  and  expensive  guns.  There  has  been  a  great 
revolution  of  sentiment  regarding  the  use  of  alcohol  since  the  beeinaing  of  the  Great 
European  War. 


718  AKMY    AND    NAVY   RATIONS 

DIET   IN   PRISON    CAMPS 

Dr.  B.  W.  Caldwell,  of  the  American  Red  Cross/  after  an  investiga- 
tion of  European  prison  camps,  in  writing  on  the  subject  in  The  Military 
Surgeon(l'2) ,  says  that  the  only  emergency  not  carefully  thought  out  and 
for  which  every  detail  of  preparation  was  not  arranged  by  the  General 
Staffs  of  the  belligerent  armies  was  the  treatment  of  the  prisoner  of  war. 
After  describing  the  conditions  of  the  prisoners  and  the  prison  camps  and 
the  precautions  taken  to  put  both  in  a  sanitary  condition,  he  describes  the 
kitchens  attached  to  the  camps  as  well  constructed  and  well  equipped  and 
in  excellent  condition  of  cleanliness.  He  observed  that  the  food  furnished 
the  prisoners  was  limited  in  variety  and  insufficient  in  quantity  and 
largely  vegetable  in  character,  consisting  of  potatoes,  carrots,  cabbage, 
turnips,  beans,  peas,  lentils  and  other  dehydrated  vegetables;  of  meals 
made  from  corn,  soy  beans  and  peas,  of  dried  fruits  and  salt  fish  and  small 
rations  of  meat.  Each  prisoner  was  allowed  coffee,  and  300  grams  of 
bread  per  day.  The  unprepared  food  was  found  to  be  of  very  good  qual- 
ity, containing  nothing  deleterious.  Necessity  has  always  been  the  mother 
of  invention,  and  as  the  prisoners  were  without  knives  and  forks,  it 
became  necessary  to  prepare  the  ration  in  such  a  manner  that  it  could  be 
served  in  large  bowls  and  eaten  with  spoons.  The  Germans  solved  this 
problem  by  cooking  the  different  articles  of  the  ration  together,  in  large 
cylindrical  cookers,  heated  with  coal,  the  cooking  process  being  continued 
until  the  whole  mass  was  soft  and  in  a  condition  to  be  eaten  with  a  spoon. 
It  was  well  seasoned  and  fairly  palatable,  but  did  not  afford  the  variety 
in  preparation  or  ingredients,  nor  was  the  quantity  sufficient,  for  a  well- 
balanced  diet,  as  will  be  seen  by  examining  the  following  actual  dietaries 
at  different  prison  camps: 

TRANSLATION  FROM  ORIGINAL  MENU  OF  THE  PRISONERS' 

KITCHEN  AT  CAMP  MUNSTER 

(November  22d  to  28th,  1916) 
Monday 

Breakfast:  Corn  mush,  100  grains;   evaporated  milk,  10  grams;   sugar,  10  grams; 

bread,  100  grams. 
Dinner:      Beans,  200  grams;   potatoes,  600  grams;    lard,  10  grams;    bread,  100 

grams. 

1  Dr.  Caldwell,  at  the  request  of  the  Amhassador  of  the  United  States  at  Berlin, 
with  the  official  approval  of  the  German  Government,  made  a  thorough  inspection 
of  the  Prison  Camps  at  MOnster,  Wittenberg,  Altdam  and  Giiterslohe  during  the 
month  of  November,  1915.  He  was  at  that  time  Director  of  the  Red  Cross  Sanitary 
Mission  to  these  Prison  Camps.  The  facts  here  so  clearly  and  dispassionately  set 
forth  are  thus  at  once  authentic  and  official. 


DIET    IN"   PEISOIT    CAMPS  719 

Supper:      Potatoes,  400  grams;    Swedish  turnips,  400  grams;    lard,   5  grams; 

bread,  100  grams. 
Tuesday 
Breakfast:  Coffee  as  on  Sunday;  bread,  100  grams. 
Dinner:      Carrots,  500  grams;    potatoes,  600  grams;    beef,   120  grams;    bread, 

100  grams. 
Supper:      Potatoes,  400  grams;    chestnuts,  150  grams;   sugar,  10  grams;   bread, 

100  grams. 
Wednesday 
Breakfast:  Barley,  50  grams;   meal  of  rolled  potatoes,  50  grams;    lard,  5  grams; 

bread,  100  grams. 
Dinner:      Swedish  turnips,  500  grams;    potatoes,  500  grams;    corned  beef,  100 

grams;  lard,  5  grams;  bread,  100  grams. 
Supper:      Potatoes,   400  grams;    sausage,   100  grams;    sauerkraut,  300  grams; 

bread,  100  grams. 
Thursday 

Breakfast:  Coffee  as  on  Sunday;  bread,  100  grams. 

Dinner:      Codfish,  200  grams;  cabbage,  400  grams;  potatoes,  600  grams;  potato 

meal,  10  grams;    oleomargarine,  10  grams;  onions,  10  grams;   spices 

as  needed;  bread,  100  grams. 
Supper:      Potatoes,  400  grams;  carrots,  500  grams;  bread,  100  grams. 
Friday 
Breakfast:  Rolled  potato  meal,  100  grams;    evaporated  milk,  10  grams;    bread, 

100  grams. 
Dinner:      Flour,  soy  bean,  120  grams;   potatoes,  600  grams;    onions,  10  grams; 

lard,  10  grams;  bread,  100  grams. 
Supper:      Potato  salad  and  potatoes,  500  grams;    oil  of  soy  bean,  500  grams; 

vinegar,  according  to  need;  one  herring;   bread,  100  grams. 
Saturday 
Breakfast:  Coffee  as  on  Sunday;  bread,  100  grams. 
Dinner:      Dried  peas,  150  grams;   potatoes,  600  grams;   bacon,  30  grams;  bread, 

100  grams. 
Supper:      Potatoes,  400  grams;  dried  vegetable,  30  grams;  lard,  5  grams;  bread, 

100  grams. 
Sunday 
Breakfast:  Coffee,  5  grams;   coffee  substitute  (Zusatz),  3  grams;  sugar,  30  grams; 

bread,  100  grams. 
Dinner:      Potatoes,    600  grams;    cabbage,   500  grams;    Cassel  spare  ribs,    100 

grams;  lard,  5  grams;   bread,  100  grams. 
Supper:      Potatoes,  400  grams;   cheese,  80  grams;   bread,  100  grams. 

MENU  OF  THE  WAR  PRISONERS'  KITCHEN,  OFFICERS'  SECTION 

AT  GtJTERSLOHE 

(November  22d  to  28th,  1915) 
Monday 
Breakfast:  Coffee,   20  grams;    coffee  substitute   (Zusatz),    10  grams;    milk,   60 
grams;  bread,  100  grams;  marmalade,  50  grams. 


720  AKMY   AND    NAVY    KATIONS 

Dinner:  Barley  (soup),  150  grams;  potatoes,  750  grams;  beef  (boiled),  125 
grams;   bread,  100  grams;   lard  and  flour  each,  20  grams. 

Supper:  Oat-flake  porridge  Avith  prunes,  500  grams;  tea,  5  grams;  sugar,  25 
grams;  bread,  100  grams. 

Tuesday 
Breakfast:  Same  as  Monday. 
Dinner:      Carrots,  150  grams;    potatoes,  750  grams;    pork  (roast),  110  grams; 

bread,  100  grams;   lard  and  flour  each,  20  grams. 
Supper:      Liver  sausage,  90  grams;   tea,  5  grams;   sugar,  25  grams;   bread,  100 

grams. 
Wednesday 
Breakfast:  Same  as  Monday. 
Dinner:      Swedish  turnips,  150  grams;    potatoes,  750  grams;    veal  (roast),  125 

grams;   bread,  100  grams;   lard  and  flour  each,  20  grams. 
Supper:      Porridge  with  milk,  500  grams;  tea,  5  grams;  sugar,  25  grams;  bread, 

100  grams. 
Thursday 
Breakfast:  Same  as  Monday. 
Dinner:      Cabbage,  150  grams;  potatoes,  750  grams;  mutton,  125  grams;  bread, 

100  grams;   lard  and  flour  each,  20  grams. 
Supper:      Salt  herring  with  boiled  potatoes  in  jackets,  500  grams;   tea,  5  grams; 

sugar,  25  grams;  bread,  100  grams. 
Friday 
Breakfast:  Same  as  Monday. 
Dinner:      Meat,  125  grams;    potatoes,  750  grams;    mustard  gravy,  100  grams; 

bread,  100  grams;  mustard,  10  grams;  lard  and  flour  each,  20  grams. 
Supper:      Liver  sausage,  90  grams;   tea,  5  grams;   sugar,  25  grams;    bread,  100 

grams. 
Saturday 
Breakfast:  Same  as  Monday. 
Dinner:      Red  cabbage,  150  grams;    potatoes,  750  grams;    bologna  sausage,  125 

grams;   bread,  100  grams;   lard  and  flour  each,  20  grams. 
Supper:      Pea  soup  with  boiled  pig's  ears,  500  grams;    tea,  5  grams;    sugar,  25 

grams;  bread,  100  grams. 
Sunday 
Breakfast:  Same  as  Monday. 
Dinner:      Roast  of  veal,  125  grams;    potatoes,  750  grams;    compote,  100  grams; 

bread,  100  grams;   lard  and  flour  each,  20  grams. 
Supper:      Holland  cheese,  90  grams;   tea,  5  grams;   sugar,  25  grams;   bread,  100 

grams. 

Alonzo  E.  Taylor,  M.D.,  writing  in  the  Journal  of  the  American  Med- 
ical Association,  Nov.  10,  1917,  on  the  "Diet  of  Prisoners  of  War  in  Ger- 
many," says  that  early  in  the  war  prisoners  subsisted  on  rations  furnished 
on  contracts.  The  contract  system  was  later  abandoned  and  the  German 
government  regimen  was  issued  in  the  spring  of  1915.     The  ration  pro- 


DIET   IN   PKISON    CAMPS 


721 


vided  German  prisoners  contained  protein,  85  grams;  fats,  40  grams;  and 
carbohydrates,  475  grams ;  with  a  total  fuel  value  of  2,700  calories.  In 
June,  1916,  the  ration  was  as  follows:  protein,  89  grams;  fat,  30  grams; 
and  carbohydrates,  510  grams;  with  a  total  fuel  value  of  2,700  calories. 

WEEKLY  DIET  SHEET  TYPICAL  OF  PERIOD  PRIOR  TO  STRINGENCY 

IN  FOODSTUFFS! 


Bread 2,100 

Flour 270 

Meat 300 

Fish 300 

Herring 150 

Potatoes 9,000 

Vegetables 1,800 

Skim  milk 400 

Sausage 200 

Cheese 100 

Nutrient  yeast 40 


Gm.     Ounces.  Gm.     Ounces. 

75         Sugar 200  7.1 

9.6      Legumes   150  5.3 

10.7      Fat 70  2.5 

10.7      Maise  grease 180  6.4 

5.3      Pearl  barley 100  3.5 

321         Dried  fruit 50  1.8 

65         Marmalade 100  3.5 

14         Tea 16  0.5 

7         Spices,  herbs 30  11.1 

3.5      Cocoa 40  1.4 

1.4 


1  Per  diem:  protein,  89  gm.;  fat,  30  gm. ;  carbohydrate,  510  gm.;  calories,  2,740. 


WEEKLY   DIET   SHEET   TYPICAL   OF   PERIOD   OF   STRINGENCY   IN 

FOODSTUFFS  ^ 


Gm.     Ounces. 


Gm.    Ounces. 


Bread 2,100 

Flour 

Meat 

Sausage 

Fish 


50 

200 

200 

325 

Potatoes 3,500 

Vegetables 1,650 

Skim  milk 500 

Cheese 100 

Nutrient  yeast 20 

Sugar 130 

Mustard 


75 
1.7 
7 
7 

11 
125 

59 

17 
3.5 
0.7 
4.8 


Legumes  150 

Fat 65 ' 

Maise  grease 100 

Pearl  barley 60 

Fruit 300 

Marmalade 100 

Tea 4 

Coffee 6 

Chicory  15 

Cocoa 40 

Spices  and  herbs 20 

50  1.7 


5.3 
2.3 
3.5 
2.1 
10.7 
3.5 
0.15 
0.21 
0.5 
1.5 
0.7 


2  Per  diem:  protein,  57  gm.;  fat,  21  gm. ;  carbohydrate,  310  gm.;  calories,  1,720. 

The  alx)ve  two  diet  sheets,  says  Taylor,  serve  to  illustrate  the  sub- 
sistence in  the  German  prisoner  of  war  camps.  The  first  is  typical  of  the 
beginning  of  food  stringency,  and  the  second  serves  as  a  contrast  of  the 


722  ARMY    AND    NAVY    RATIONS 

present  deplorable  shortage  of  foodstuffs.  Taylor  points  out  from  these 
figures  the  necessity  of  our  government  taking  cognizance  of  the  food 
conditions  in  Germany,  aod  suggests  that  steps  be  taken  to  organize  ways 
and  means  to  feed  Americans  who  may  be  taken  prisoners  of  war  by 
Germany. 


CONCLUSIONS    REGARDING    THE    COMPOSITION    AND    FOOD 
VALUE    OF    THE    MILITARY    RATION  (HARVARD)  (4) 

"We  have  previously  stated,  on  good  grounds,  that  an  adult  man  weigh- 
ing 154  pounds  is  in  better  physical  condition,  stronger,  and  capable  of 
greater  endurance,  with  a  ration  yielding  2,800  calories,  especially  if  the 
proteins  are  kept  within  a  maximum  of  60  grams,  than  with  one  greatly 
exceeding  this  value.  But  we  have  seen  that  in  our  service,  as  in  all  other 
leading  countries,  the  soldier's  ration  exceeds  these  limits  in  the  number 
of  calories,  which  range  from  3,000  to  5,000,  but  especially  in  the  amount 
of  proteins  (Japanese  excepted),  which  hardly  ever  fall  below  100  and 
often  range  up  to  160  or  more  grams.  There  is  no  indication,  therefore, 
that  in  this  country  or  in  Europe  the  soldier  is  underfed,  provided  he 
actually  receives  the  ration  called  for  by  military  regulations. 

"Much  has  been  written  on  the  necessity  of  feeding  the  soldier  well  and 
much  attention  and  study  have  been  devoted  to  the  composition  of  ade- 
quate rations.  That  he  should  be  sufficiently  and  properly  fed,  needs  no 
discussion,  but  the  belief  generally  entertained  that  the  more  he  eats  the 
greater  is  his  energy  and  efficiency  is  groundless  and  mischievous.  The 
danger  of  overeating  has  been  too  much  overlooked,  or  else  esteemed  a 
negligible  factor.  It  is  the  opinion  of  many  careful  observers  that  the 
American  soldier  is  much  more  likely  to  be  overfed  than  underfed,  and 
that  his  health  and  efficiency  stand  in  greater  peril  from  excess  than  from 
lack  of  food.  As  a  general  rule,  the  soldier  does  not  know  how  to  regu- 
late his  appetite,  nor  does  he  appreciate  the  necessity  of  doing  so.  He  eats 
what  is  allowed  him  hurriedly  and  often  without  proper  mastication,  and 
between  meals  frequently  patronizes  the  lunch  counter  of  the  post 
exchange  or  the  outside  shop  where  pies  and  other  tempting  pastry  are 
displayed.  This  is  characteristic  of  the  soldiers  of  all  countries,  particu- 
larly of  those  who  receive  the  most  liberal  rations.  Thus,  the  remarks  of 
Rouget  and  Dopter,  in  their  'Hygiene  Militaire,'  although  aimed  at  their 
countrymen,  are  of  very  general  application.  'Many  Frenchmen,  espe- 
cially in  the  country,  have  the  pernicious  habit  not  to  cease  eating  until 


CON^CLUSIOXS    EEGARDING    MILITARY    RATIONS    723 

they  experience  a  sensation  of  fullness  in  the  stomach.  Little  do  they  care 
about  the  nutritive  value  of  the  food  ingested.  Their  conviction  is  that, 
so  long  as  this  abdominal  repletion  is  not  distinctly  felt,  they  have  not 
been  sufficiently  fed.  This  is  particularly  observed  each  year  at  the  time 
of  the  incorporation  of  the  new  contingent.  The  amount  of  bread  in  the 
ration,  although  considerable,  is  not  enough  to  satiate  these  young  sol- 
diers ;  they  buy  more  from  outside  bakeries.' 

"It  should  be  remembered  that  within  an  hour  or  two  after  taking  a 
full  meal,  at  least  a  pint  of  gastric  juice  is  poured  into  the  stomach  and 
added  to  its  contents,  so  that  what  was  at  first  mere  repletion  may  become 
imcomfortable  distention.  Soldiers  should  be  advised  that  a  sensation  of 
fullness  or  distention  following  a  meal  is  a  clear  admonition  that  they 
have  eaten  too  much,  and  that  if  such  excess  is  kept  up,  as  a  habit,  they 
will  surely  suffer  in  health  and  efficiency.  Such  advice  may  do  good,  but 
more  practical  results  will  follow  if  the  food,  especially  the  meat,  as 
served  in  the  mess-room,  is  simply  sufficient  and  not  wastefully  abun- 
dant. 

"Experience  shows  that  it  is  while  actively  engaged  in  the  field,  when 
the  rations  are  reduced  and  the  cooking  simple,  that  the  men  enjoy  the 
best  health  and  show  most  endurance,  provided,  of  course,  there  is  no 
actual  lack  of  food.  Thus,  during  the  active  part  of  the  Santiago  cam- 
paign in  1898,  there  was  but  little  sickness  in  spite  of  the  trying  climate 
and  of  short  commissary  supplies,  but  as  soon  as  the  work  was  over  and 
rations  became  abundant,  the  morbidity  began  to  rise  and  before  long 
exceeded  seventy-five  per  cent  of  the  command.  It  is  hard  to  resist  the 
conviction  that  injudicious  feeding  was  responsible  for  many  of  the  cases 
of  'undetermined  fever,'  and  prepared  the  way  for  much  of  the  malaria 
which  prevailed  in  our  camps  near  Santiago,  as  well  as  of  the  typhoid 
fever  which  decimated  our  troops  in  the  United  States.  It  is  noteworthy 
that  the  Spanish  soldiers  in  Santiago,  although  reduced  to  very  scant 
rations  of  poor  quality,  had  a  much  smaller  proportion  of  sick  than  the 
American  troops. 

"During  the  Boer  War  in  South  Africa,  the  English  troops  besieged 
in  Ladysmith  were  fed  for  several  months,  according  to  Dunlop,  on  a 
ration  of  73  grams  of  protein,  69  of  fat,  and  141  of  carbohydrates,  witli 
fuel  value  of  only  1,527  calories,  but  which,  as  remarked  by  Munson,  fur- 
nished energy  enough  for  a  stout  and  successful  resistance.  The  Russo- 
Japanese  War  has  taught  us  an  important  lesson  in  dietetics.  Both 
Russians  and  Japanese  had  meat  rations  much  smaller  than  those  pro- 
vided for  American,  English  and  French  soldiers ;  the  meat  ration  of  the 


724  AEMY    AND    NAVY   RATIONS 

Japanese,  in  particular,  was  decidedly  meager  and  often  lacking  altogether. 
Yet  we  know  that  no  armies,  during  an  arduous  war  of  twenty  months, 
ever  suffered  so  little  from  infectious  diseases  and  had  fewer  men  inca- 
pacitated from  sickness.  To  what  extent  this  immunity  is  due  to  the 
food  can  only  be  conjectured.  It  certainly  cannot  be  attributed  exclu- 
sively to  the  sanitary  measures  taken,  for  it  was  the  opinion  of  the  Amer- 
ican and  English  attaches  with  both  armies,  that  had  their  own  troops 
been  placed  under  similar  conditions,  but  fed  with  their  own  rations, 
typhoid  fever  would  undoubtedly  have  prevailed  among  them  in  an  epi- 
demic form.^  It  is  true  that  the  Japanese  suffered  much  from  beriberi 
during  this  war,  a  disease  known  to  be  due  to  an  excess  of  rice  combined 
with  a  deficiency  of  protein,  but  there  is  no  doubt  that  it  would  have  been 
entirely  prevented  had  the  Japanese  soldier  received  one-half  of  the  pro- 
tein component  called  for  by  the  ration  of  the  United  States  soldier. 

"Surgeon  Tsui  of  the  Chinese  army (13)  states  that,  in  Northern 
China,  the  country  laborers  from  whom  the  army  is  mostly  recruited,  men 
of  fine  physique  and  most  remarkable  power  of  endurance,  live  almost 
exclusively  on  a  vegetable  diet.  The  Chinese  soldier  receives  meat  only 
twice  a  month.  The  rates  of  sickness  and  death  in  the  Chinese  army, 
according  to  this  trustworthy  authority,  are  much  lower  than  in  our 
army. 

"Formerly,  the  price  of  savings  made  from  the  ration  and  paid  by  the 
Quartermaster  Corps  to  the  organization  commander,  could  be  expended 
by  the  latter  in  any  way  deemed  most  advantageous  to  the  organization, 
that  is,  not  only  in  the  purchase  of  other  kinds  of  food,  but  of  any  arti- 
cles intended  for  the  comfort  and  enjoyment  of  the  men,  such  as  games," 
sporting  goods,  etc.  Under  existing  regulations,  money  received  as  bal- 
ance of  the  'ration  and  savings  account'  can  be  spent  only  for  food.  It 
follows  that  the  company  commander  has  no  longer  any  discretion  in  regu- 
lating the  amount  of  food  consumed  by  his  men,  but  is  expected  to  expend 
the  entire  money  value  of  the  ration  in  the  purchase  of  foodstuffs." 
Colonel  Harvard (4)  cannot  commend  this  change.  He  believes  that  the 
former  system,  whereby  the  company  commander  was  allowed  discretion 
in  regulating  the  quantity  as  well  as  the  quality  of  the  food,  was  better 
calculated  to  safeguard  the  health  and  comfort  of  his  men. 

NAVY    RATIONS 

During  recent  years  much  attention  has  been  given  to  the  selection  and 
preparation  of  the  ration  for  the  United  States  sailor.     In  former  days, 
1 1  question  this  statement. — G.  N.  K. 


l^AVY    RATIONS  725 

it  was  a  notorious  fact  that  the  character  of  the  food  on  board  ship  was 
monotonous,  uninviting  and  led  to  nutritional  disorders.  In  the  present 
navy  ration,  according  to  the  Revised  Statutes,  ^  the  following  allowances 
of  provision  constitute  the  daily  ration: 

1  pound  hard  bread  (biscuits);  or  IJ^  pounds  fresh  bread;  or  1)^  pounds  flour 

1  pound  tinned  meat;  or  IJ^  pounds  of  salt  meat;  or  1^  pounds  smoked  meat; 

or  1%  pounds  fresh  meat;  or  1%  pounds  fresh  fish;  or  8  eggs;  or  1^  pounds 
poultry 
%  pound  tinned  vegetables;  or  1^  pounds  fresh  vegetables;   or  3  gills  beans  or 
peas;  or  J^  pound  rice  or  other  cereal 

2  ounces  coffee;  or  2  ounces  cocoa;  or  3^  ounce  tea 

1  ounce  evaporated  milk;   or  Vi«  quart  fresh  milk 

Vi6  pound  dried  fruit;  or  %  pound  tinned  fruit;  or  Vie  pound  fresh  fruit  (one 
ration  of  fruit  is  allowed  with  each  ration  of  beans,  peas,  rice  and  other  starch 
foods  and  canned  vegetables  issued) 

2  ounces  butter 
4  ounces  sugar 

7  ounces  lard  for  every  100  pounds  flour  used  as  bread 

The  weekly  ration  consists  in  addition  of  the  following: 

\i  pound  cheese  14,  pound  salt 

14      "      macaroni  J^  pint  sirup 

V32     "      pepper  V128  pound  spices 

yi      "      pickles  yi  pound  tomatoes  (canned) 

V32     "      mustard  3^  pint  vinegar  or  oil 

Yeast,  baking  powder  and  flavoring  extracts  as  required 

In  addition  to  the  foregoing,  the  following  issues  are  allowed  to  men 
of  the  engineer  and  dynamo  force  standing  watch  under  steam  between 
the  hours  of  8  p.m.  and  8  a.m. 

4  ounces  hard  bread  or  its  equivalent 

1  ounce  coffee 

4  ounces  tinned  meat  or  its  equivalent 

2  "      sugar 

The  following  substitution  for  the  components  of  the  ration  may  be 
made  when  deemed  necessary  by  the  senior  officer  present  in  command. 
Articles  of  combined  ration  components  will  be  regarded  as  ration  equiv- 
alents and  issued  in  accordance  with  the  following  table  ^ : 


1  Naval  Act  of  June  29,  1906,  and  March  2,  1907. 

2  Memo.  No.  74,  Navy  Dept.,  Sept.  1,  1915.     For  the  guidance  of  officers,  beginning 
with  the  second  quarter  of  the  year  1916. 

146 


726 


ARMY   AND    NAVY   RATIONS 


NAVY  RATIONS  AND  COMPONENTS 


Components 


Bread: 

Biscuit 

Crackers: 

Soda 

Oyster 

Bread,  fresh: 

Wheat 

Graham 

RoUs 

Flour: 

Wheat 

Graham 

Buckwheat 

Com  meal 

Meat: 
Preserved: 
Tinned: 

Bacon 

Corned  beef 

Chipped  beef 

Codfish  and  haddock 

Salmon 

Sardines 

Sausage  (Vienna).. . 

Luncheon  meat 

Salt: 

Corned  beef,  fresh. . . . 

Salt  pork 

Salt  mackerel 

Smoked: 
Bacon,  sugar  cured  and 

smoked 

Ham,  sugar  cured  and 

smoked 

Shoulder,  sugar  cured 

smoked 

Sausage,  frankfurters. 

Sausage,  bologna 

Tongues,  beef 

Fresh: 

Beef 

Mutton 

Pork 

Veal 

Sausage,  poric 

Liver,  beef 


Ration 
allowance 


1  pound 

1      " 
1      " 

1  yi  pounds 

\%       « 

\y%    " 


pound 


1  Ji  pounds 


IM 


IK 


Components 


Meat:     (Continued) 
Fresh:     (Continued) 

Hamburger  steak. 

Chicken 

Fowl 

Turkey 

Fish,  fresh 


Vegetables: 
Dried: 
Beans: 
Navy. . . 
Lima . . . 
Kidney. . 
Peas,  spUt. 

Canned: 
Beans: 

Lima . .  . 

String... 

Com 

Peas 

Tomatoes . 
Pumpkin. . 
Beets 


Fresh: 

Turnips 

Carrots 

Tomatoes 

Beets 

Onions,  green 

Squash 

Pumpkin 

String  beans 

Peas,  green,  in  pod.  . 
Corn,  green,  sugar,  on 

cob,  in  husk 

Spinach 

Cauliflower 

Lettuce 

Cucumbers 

Celery 

Radishes 

Rhubarb 

Parsnips 


Ration 
allowance 


1 H  pounds 

IH      " 

IH      « 
8  (number) 


3  gills 


H  pound 

3X        « 


1 H  pounds 

IH  " 

UA  « 

m  " 

1%  « 

IH  " 

IH  " 

m  " 


NAVY   RATIONS 


727 


NAVY  RATIONS  AND  COMPONENTS— ConftViMed 


Components 


Vegetables:    (Continued) 
Fresh:     (Continued) 

Eggplant 

Peppers,  green  and  I'fed 

Asparagus 

Parsley 

Potatoes: 

Irish 

Sweet 

Onions 

Cabbage 

Cereals  and  starch  foods 

Rice 

Cornstarch 

Barley 

Hominy 

Oats,  rolled 

Tapioca 

Fruit: 
Dried : 

Apples 

Citron 

Currants 

Cocoanut,  shredded 

Peaches 

Raisins 

Canned : 

Apples 

Apricots 

Peaches 

Pears 

Pineapple 

Prunes 

Preserved: 

Jams 

Apple  butter 

Mincemeat 

Fresh: 

Peaches 

Pears 

Cherries 

Grapes 

Berries,  all  kinds. .  . 

Cranberries 

Watermelon 

Cantaloupe 


Ration 
allowance 


1 M  pounds 

m    " 

m    " 
m    " 

J4  pound 
'A      " 
Yl      " 
K      " 
Yi      " 


Vs 
Vs 
Vs 
% 


% 

% 
% 
% 

%, 
% 
%. 
% 


Components 


Fruit:     (Continued) 
Fresh :     ( Continued) 

Plums 

Grapefruit 

Pineapple 

Apples 

Bananas 

Lemons 

Oranges 

Beverages : 

Coffee 

Cocoa 

Tea 

Milk: 

Evaporated 

Fresh 

Extracts,  flavoring: 

Vanilla 

Lemon 

Vinegar  and  sauces : 

Vinegar 

Oil,  salad 

Sauce,  Worcestershire 

Catsup 

Butter 

Cheese 

Baking  powder 

Baking  soda 

Hops 

Lard 

Oil,  cottonseed 


Macaroni  and  vermicelli . . 

Mustard 

Pepper,  black  and  cayenne 
Pickles  and  sauerkraut. . . . 

Salt 

Syrup 

Spices,  assorted 

Sugar 

Yeast 

Tomatoes 


Ration 
allowance 


%  pound 

%,      « 
%      « 


V32     " 

/l6  quart 
'A      " 

As  needed 


Y  pt.  weekly 
V2    "        " 
V2    "       " 
'A    "       " 
H  lb.  daily 
H    "      " 
As  needed 


7  lbs.  to  every 
100  lbs.  flour 
as  bread 

As  lard  sub- 
stitute in  the 
proportion 
of  1  gal.  to 
10  pounds 
lard 

A  lb.  weekly 

V32  «        " 

V32  " 

H    "       " 

H   "       " 

Jipt.      « 
Vi28  lb.      « 

H    "  daily 
As  needed 

}4  lb.  weekly 


728  ARMY   AND    NAVY    RATIONS 

The  extra  allowance  of 

2  ounces  sugar 

4  ounces  hard  bread  or  its  equivalent 

1  ounce  coffee  or  cocoa 

4  ounces  preserved  meat  or  its  equivalent 

is  allowed  to  enlisted  men  of  the  engineer  and  dynamo  force  who  stand 
night  watches  between  eight  o'clock  p.m.  and  8  o'clock  a.m.,  under  steam. 

According  to  provisions  promulgated  by  the  Secretary  of  the  Navy^ 
any  article  comprised  in  the  navy  ration  may  be  issued  in  excess  of  the 
authorized  quantity  provided  there  is  an  under-issue  of  the  same  value 
in  some  other  article  or  articles  of  food. 

Gatewood,  in  discussing  navy  rations,  says : 

Contentment  in  naval  service  in  relation  to  food  and  water  makes  for  good 
discipline,  and  work  without  contentment  is  impossible.  Contentment  facilitates 
voluntary  enlistment,  and  a  service  that  supplied  protein  food  in  amounts  exactly 
to  meet  the  requirements  of  the  body  as  evolved  from  the  mathematics  of  nitro- 
genous equiUbrium  would  not  secure  contentment.  That  is  the  basis  of  the  daily 
amounts  of  food  in  the  navy  ration,  the  amounts  depending  essentially  not  upon 
what  it  is  thought  men  ought  to  eat,  but  upon  what  experience  has  demonstrated 
they  desire  to  eat. 

The  navy  ration  has  been  particularly  studied  and  carefully  arranged 
from  the  point  of  view  of  efficient  service.  The  variety  and  components 
permit  of  sufficient  elasticity  to  prevent  monotony  in  the  dietary.  The 
selection  of  food  is  of  great  moment  and  with  the  aid  of  preserved  and 
canned  meats,  fruits  and  vegetables,  quite  a  variety  in  the  dietary  can 
be  furnished  aboard  ship.  The  ration  aboard  ship  will  vary  according  to 
climatic  conditions.  The  dietary  in  tropical  countries  will  be  different 
from  that  in  cooler  regions.  Appetite  and  digestion  are  influenced  more 
or  less  by  changing  temperatures  and  humidity.  It  is  also  quite  probable 
that  the  efferent  nerve  supply  on  the  surface  of  the  body  reacts  to  external 
climatic  influences  and  exerts  a  retarding  effect  upon  metabolism.  Pre- 
cise information  as  to  the  energy  or  nutritive  value  of  the  navy  ration  is 
not  readily  obtainable  without  carefully  taking  into  account  whether  the 
energy  or  fuel  value  should  be  reckoned  on  the  ration  as  issued,  or  as  con- 
sumed. Surgeon  Gatewood,  U.  S.  N.,  worked  out  a  table  showing  the 
comparative  average  energy  values  of  the  ration  of  the  United  States  navy 
as  contrasted  with  those  of  the  navies  of  other  nations.  He  summed  up 
the    subject    in    the    following    table,    showing   the    various    percentage 


1  Naval  Act,  March  2d,  1907. 


NAVY    RATIONS 


729 


elements  of  the  dietary  ingested  and  digested  and  the  actual  energy  or 
caloric  values  of  each : 

COMPARATIVE  NUTRITIVE  ENERGY  OF  AMERICAN  AND  FOREIGN 

NAVY  RATIONS 


Naval  Dietaries 


1.  U.  S.  Navy  (sea  ration) . 

2.  U.  S.  Navy  (fresh  pro- 

visions)  

3.  U.  S.  Navy  (usual) 

4.  U.    S.    Navy    (engineer 

force)  

5.  JapaneseNavy  (average) 

6.  French  Navy  (average). 

7.  French  Navy  (engineer 

force)  

8.  British  Navy  (average). 

9.  British  Navy  (engineer 

force)  


Eaten 


Pro- 
tein 


Gm. 

138 

145 
142 

182 

126 
170 

184 
127 

175 


Fat 


Gm. 
269 

135 
192 

218 

56 
34 

35 
110 

149 


Car- 
bohy- 
drates 


Gm. 
556 

444 
492 

624 

607 

524 

608 
601 

728 


Digestible 


Pro- 
tein 


Gm. 

127 

134 
131 

168 

116 
156 

169 
117 

161 


Fat 


Gm. 
256 

129 

183 

207 

53 
32 

33 
104 

141 


Car- 
bohy- 
drates 


Gm. 
540 

431 

478 

606 

589 
508 

590 
583 

706 


UtiHz 

able 

energy 


Gals. 
5,180 

3,563 
4,256 

5,174 

3,430 
3,078 

3,407 
3,891 

4,938 


Nutri- 
tive 
ratio 


1 

8.7 

5.3 

6.7 

6.3 

6.1 
3.7 

3.9 
7.2 

6.6 


The  estimates  in  Gatewood's  table  concerning  the  percentage  elements 
of  the  ration  of  the  French  navy  must  be  accepted  with  a  little  reserva- 
tion, since  it  is  not  clear  whether  all  the  necessary  factors  have  been 
included  or  whether  correct  allowance  has  been  made  for  waste.  It  may 
be  that  the  ration  is  given  as  issued  and  not  as  consumed.  The  percentage 
elements  recorded  for  the  Japanese  navy  seem  to  be  rather  low,  but  it 
must  be  taken  into  consideration  that  the  weight  of  the  average  enlisted 
man  in  the  Japanese  navy  is  only  about  129  pounds.  It  will  be  seen  from 
the  examination  of  this  table  that  the  average  sailor  in  the  United  States 
navy  consumes  daily,  142  grams  of  protein,  193  grams  of  fat,  and  492 
grams  of  carbohydrates,  yielding  a  fuel  value  of  4,256  calories.  The 
engineer  force  receives  an  additional  issue  of  42  grams  of  protein,  24 
grams  of  fat,  and  122  grams  of  carbohydrates.  This  allowance  gives  the 
engineer  force  more  protein  than  is  given  in  Atwater's  Standards  for  a 
man  at  hard  muscular  labor. 

In  arranging  the  navy  ration,  several  points  of  view  must  be  taken 


730  AEMY    AND    NAVY    RATIONS 

into  consideration.  First,  the  ration  must  be  what  the  sailor  should  have, 
and  second,  it  ought  to  be  what  he  wants.  The  availability  of  the  ration, 
its  keeping  qualities  and  its  storage  are  also  matters  to  be  carefully  con- 
sidered. Again,  the  all  important  question  of  securing  an  aliment  which 
will  yield  the  proper  amount  of  nutriment  within  a  fixed  daily  cost  per 
capita  must  be  taken  into  consideration.  These  and. many  other  pertinent 
questions  have  been  very  carefully  and  satisfactorily  considered  in  an 
excellent  article  by  Surgeon  J.  D.  Gatewood  of  the  United  States  navy  in 
his  work  on  ''Naval  Hygiene." 

The  United  States  navy,  by  authority  of  its  secretary,  has  issued  a 
"General  Mess  Manual  and  Cook  Book"^  for  use  on  board  vessels  of  the 
United  States  navy,  which  gives  much  interesting  data  concerning  the 
organization  and  administration  and  general  management  of  the  Commis- 
sary of  the  United  States  navy. 

PART    I.     THE    GENERAL   MESS 

Organization  and  Administration. — 1.  The  general  messing  system  is,  by 
regulations,  obligatory  on  board  of  all  vessels  of  the  Navy.  The  mess  must 
include  all  enlisted  men  of  the  Navy  and  Marine  Corps,  except  chief  petty  offi- 
cers and  officers'  ser\'ants,  and  its  members  are  to  be  divided  into  messes  of  about 
twenty  men  each,  and  as  nearly  as  possible  messed  by  divisions  instead  of  by 
rations,  as  has  heretofore  been  the  custom.  By  this  method  the  petty  officers  will 
be  scattered  among  the  messes  and  there  can  be  no  complaint  on  account  of  dis- 
crimination— all  faring  alike. 

2.  A  messman  is  to  be  detailed  for  each  mess,  and  he  is  to  receive  the  food 
from  the  cooks  at  the  galley,  ser\'e  it  at  the  mess  table,  and  is  responsible  for  the 
care  and  the  cleanliness  of  the  mess  gear  and  mess  tables. 

3.  The  chief  commissary  steward,  or  commissary  steward,  the  cooks  and 
bakers,  together  with  the  storekeeper  (when  a  store  is  established  on  the  ship), 
form  the  enlisted  force  of  the  commissary  department.  They  are  the  assistants 
of  the  pay  officer  and  belong  to  the  pay  division. 

4.  The  responsibility  of  the  commissary  and  his  assistants  ceases  with  the 
delivery  of  the  food  to  the  messman  at  the  galley. 

5.  The  established  rate  of  pay  being  sufficient  to  secure  the  services  of  com- 
petent and  experienced  men,  the  payment  of  any  g^ratuity,  either  by  the  com- 
missary or  by  the  men  themselves,  to  any  person  employed  in  the  service  of  the 
general  mess  is  forbidden  by  the  regulations. 

6.  The  commanding  officer  should  see  that  proper  facilities,  including  such 
boats  and  men  as  may  be  necessary,  are  afforded  the  commissary  for  getting  mess 
stores  on  board  and  stowing  them. 


1  Government  Printing  Office,  Washington,  D.  C,  1904. 


NAVY    EATIONS  731 

7.  It  should  be  thoroughly  understood  that  the  general  mess  is  not  an  organ- 
ization managed  by  its  members,  as  was  the  "berth-deck  mess." 

8.  In  addition  to  the  pay  provided  for  enlisted  men,  the  Government  under- 
takes to  subsist  them,  and  this  it  does  at  whatever  expense  may  be  necessary. 
The  fixed  value  of  commutation  for  one  ration  is,  by  law,  30  cents,  but  the  com- 
mutation of  rations  is  a  privilege,  not  a  right,  and  the  idea  prevalent  among 
enlisted  men  that  they  are  entitled  to  receive  just  30  cents'  worth  of  food  each 
day  or  30  cents  in  money,  is  erroneous.  While  the  regulations  limit  commuta- 
tion to  one-fourth  the  total  number  of  rations,  they  do  not  require  any  commuta- 
tion at  all,  this  being  purely  a  question  of  desirability  and  business  expediency 
to  be  decided  by  the  pay  oflScer  with  the  approval  of  the  commanding  officer. 

9.  Under  the  general  messing  system  the  Government  subsists  the  men 
entirely,  and  they  have  no  more  voice  in  the  management  of  the  commissary 
department  than  in  any  other  department  of  the  ship.  The  Government,  through 
its  authorized  officer,  provides  them  with  the  ration  allowed  by  law.  The  food 
is  purchased,  cooked,  and  served  entirely  at  the  Government  expense,  and  its 
value,  whether  it  be  more  or  less  than  30  cents  per  diem  per  man,  is  a  matter  with 
which  the  men  themselves  have  nothing  to  do. 

10.  In  case  any  man  considers  that  he  is  improperly  subsisted,  he  has  the 
right,  which  all  persons  in  the  Navy  have,  to  state  his  grievance  at  the  proper 
time  and  place  to  his  commanding  officer,  who  should  then  cause  the  commissary 
to  investigate  the  matter,  and,  if  the  complaint  is  well  founded,  to  take  steps  to 
place  the  responsibility  and  to  prevent  a  recurrence  of  the  fault  complained  of. 

11.  The  men  are  entitled  to  the  full  benefit  of  the  money  and  stores  allowed 
for  their  subsistence,  and  no  expenditure  can  be  made  from  the  general  mess 
fund,  except  for  the  benefit  of  the  mess ;  nor  can  any  of  this  money  or  these  stores 
be  withheld  (when  they  can  be  used  to  advantage)  and  allowed  to  accumulate  as 
a  surjjlus.  In  cases,  however,  where  a  surplus  of  either  money  or  stores  does 
unavoidably  exist  when  a  ship  is  placed  out  of  commission,  the  members  of  the 
mess  have  no  claim  whatever  to  any  part  of  it  and  it  reverts  to  the  Government, 
the  stores  being  taken  up  as  a  gain  on  issues  and  the  money  being  credited  to 
the  appropriation  "Provisions,  Navy." 

12.  Subsistence  of  enlisted  men  absent  from  the  ship  on  duty  will,  when 
practicable,  be  furnished  by  the  general  mess.  When  men  are  landed  in  large 
numbers  for  an  expedition  or  for  going  into  camp  with  the  expectation  of  being 
absent  from  the  ship  for  more  than  twenty-four  hours,  the  paymaster's  clerk  or 
the  commissary  steward,  or  both,  according  to  the  proportion  of  the  ship's  com- 
pany landed  and  the  importance  of  the  expedition,  together  with  such  cooks  and 
bakers  as  may  be  necessary,  and  a  sufficient  number  of  messmen,  should  consti- 
tute the  commissary  corps. 

13.  Special  attention  is  invited  to  Articles  387,  391,  392,  753,  and  1402,  Navy 
Regulations,  as  amended  by  General  Orders  68,  105,  and  119.  It  will  be  noted 
that  the  board  of  audit  is  required  to  make  its  report  to  the  commanding  officer 
monthly  and  in  writing;  its  recommendations  being  based  upon  facts  adduced  in 
the  audit  of  the  mess  accounts,  and  confined  to  its  financial  feature  alone. 


732  AKMY   AND   NAVY   RATIONS 

The  Commissary. — 14.  The  pay  officer  of  the  ship,  or,  in  ships  having  no 
pay  officer,  an  officer  designated  by  the  captain  is  the  commissar}',  and  is  solely 
responsible  for  the  purchase  and  preparation  of  the  food  for  the  general  mess, 
the  care  of  the  stores,  and  the  judicious  expenditure  of  mess  funds,  keeping  the 
accounts  of  the  mess  and  administering  all  its  affairs  except  the  serving  of  the 
food  at  the  mess  table. 

15.  His  authority  in  the  performance  of  these  duties  is  commensurate  with 
his  responsibility,  and  all  persons  employed  in  the  service  of  the  general  mess 
are  subject  to  his  orders. 

16.  The  commissary  should  frequently  inspect  the  storerooms  allotted  to 
the  general  mess  and  see  that  the  stores  are  properly  stowed  and  that  the  rooms 
are  dry  and  well  ventilated.  Any  deterioration  in  the  stores  being  a  direct  loss  to 
the  mess,  great  care  should  be  exercised  in  their  selection,  and  no  greater  quantity 
should  be  bought  at  one  time  than  can  be  used  within  the  period  they  may  be 
expected  to  keep  in  good  condition. 

17.  The  commissary  should  not  permit  any  stores  to  be  purchased  until  a  list 
of  them  has  been  submitted  to  him  and  carefully  examined  and  approved.  No 
stores  should  be  received  on  board  unless  accompanied  by  a  bill  or  memorandum 
by  which  they  can  be  checked  off;  and  before  being  stowed  away  all  stores 
should  be  carefully  inspected  by  the  commissary  or  the  commissary  steward.  No 
bills  should  be  contracted  that  can  not  be  paid  from  the  funds  in  hand  or  by  the 
ration  money  that  will  accrue  to  the  mess  during  the  current  month.  All  bills 
should  be  settled  at  the  end  of  each  month,  and  always  before  the  ship  sails 
from  port. 

18.  The  commissary  should  keep  the  cash  accounts  of  the  mess  so  that  they 
can  be  conveniently  audited  by  the  general  inspector  of  the  pay  corps,  the  pay- 
master of  the  fleet,  or  by  the  board  appointed  for  the  purpose.  All  expenditures 
must  be  substantiated  by  vouchers,  which  are  to  be  exhibited  when  the  accounts 
are  inspected. 

19.  He  should  cause  the  commissary  steward  to  keep  a  stock  account  which 
should  embrace  all  stores  and  all  property  of  the  general  mess.  The  value  of  the 
balance  shown  upon  this  stock  account  should  be  taken  into  consideration  in  mak- 
ing up  the  statement  of  the  financial  condition  of  the  mess. 

20.  The  commissary  should,  when  he  deems  it  advisable,  submit  written  re- 
ports and  recommendations  to  the  captain  regarding  the  general  mess,  and  he 
must  do  so  whenever  the  interests  of  the  mess  require  any  change  which  he,  him- 
self, is  not  authorized  to  make. 

21.  The  commissary  should  mark  the  enlisted  men  of  his  department  in 
proficiency  in  rating  and  should  immediately  report  any  inefficiency  or  careless- 
ness in  their  performance  of  duty. 

22.  He  should  frequently  inspect  the  food  before  it  is  delivered  to  the  mess 
men  at  the  galley,  and  in  ease  he  finds  it  improperly  prepared,  should  take  steps 
to  prevent  any  further  occurrence  of  the  kind.    If  cooks  are  not  thoroughly  com- 


NAVY    RATIONS  733 

petent,  they  'Should  be  made  to  follow  strictly  the  recipes  in  this  book,  and  fla- 
grant eases  of  incompetency  should  be  reported. 

The  Commissary  Stewards. — 23.  The  chief  commissary  steward  or  commis- 
sary steward  is  the  chief  petty  officer  in  charge,  under  the  commissary,  of  the 
general  mess.  He  is  entitled  to  respect  and  obedience  from  all  persons  of  inferior 
rating  while  in  the  performance  of  his  duties,  and  he  is  responsible  for  the  proper 
execution  of  the  orders  of  the  commissary.  The  daily  bill  of  fare  should  be  made 
out  by  the  commissary  steward  and  submitted  to  the  commissary,  and  the  neces- 
sary stores  issued  to  the  cooks  at  the  galley.  He  should  direct  the  manner  of  its 
preparation  and  shall  be  in  charge  of  the  galley  and  the  men  employed  at  it,  and 
should  frequently  inspect  the  food  before  it  is  delivered  to  the  messmen  to  be 
served.  He  should  see  that  the  galley  and  all  the  galley  utensils  are  kept  in  proper 
condition,  giving  particular  attention  to  their  cleanliness. 

24.  He  should  report  to  the  commissary  daily,  in  writing,  all  purchases  made 
and  debts  contracted,  and  keep  that  officer  advised  of  the  needs  of  the  mess.  He 
is  to  draw  from  the  pay  department,  at  the  appointed  time,  such  government 
stores  as  are  due  the  mess,  and  must  keep  an  account  of  these  stores  for  the  veri- 
fication of  the  provision  return  at  the  end  of  each  quarter.  When  fresh  provisions 
are  issued  he  should  be  on  deck,  when  practicable,  to  receive  them  from  the  repre- 
sentative of  the  pay  department  as  soon  as  they  have  been  received  on  board  and 
inspected.  In  case  these  fresh  provisions,  or  any  other  stores  issued  to  the  mess 
by  the  pay  department  are,  in  the  opinion  of  the  commissary  steward,  of  inferior 
quality  and  unfit  for  issue,  he  should  report  the  matter  to  the  commissary,  who 
shall  make  a  personal  investigation,  and,  in  case  he  finds  the  objection  well 
founded,  should  take  the  necessary  steps  to  provide  other  stores,  as  prescribed  by 
the  regulations.  An  issuing  book  should  be  kept  by  the  pay  yeoman  and  signed 
daily  by  the  commissary  steward,  in  order  that  no  question  may  arise  at  the  end 
of  the  quarter  as  to  the  stores  drawn  by  the  general  mess.  The  commissary 
steward  may,  with  the  authority  of  the  commissary,  draw  from  the  pay  depart- 
ment such  government  stores  as  are  required  in  excess  of  the  allowance,  and 
these  stores  shall  be  paid  for  from  the  mess  fund  at  the  end  of  each  month. 

The  Cooks. — 25.  The  senior  cook,  or,  if  there  are  two  or  more  of  the  same 
rating,  one  selected  by  the  commissary,  should  be  in  immediate  charge  of  the 
galley  and  act  in  the  capacity  of  head  cook.  He  should  be  held  strictly  respon- 
sible for  the  cleanliness  of  the  galley  and  the  utensils  pertaining  to  it,  for  the 
maintenance  of  discipline  among  his  assistants,  for  the  proper  preparation  of  the 
food,  and  for  having  the  meals  ready  at  the  prescribed  hours.  He  should  per- 
sonally superintend  the  cooking  of  all  meals,  and  should  carefully  inspect  all 
food  before  it  is  delivered  to  the  messmen.  It  is  his  duty  to  report  to  the  com- 
missary any  inefficiency  or  neglect  on  the  part  of  his  assistants;  otherwise  the 
entire  blame  for  poor  cooking  or  any  other  delinquency  at  the  galley  should  rest 
upon  him.  The  head  cook  should  keep  the  commissary  steward  informed  as  to 
the  requirements  of  the  galley,  and  should  from  time  to  time  prepare  lists  of  arti- 
cles required  by  him  in  his  cooking,  which  are  not  included  in  the  Navy  ration. 
He  is  responsible  for  the  galley  utensils  and  will  report  immediately  when  they 
are  lost  or  damaged. 


734  AEMY    AND    NAVY   KATIONS 

26.  The  other  cooks  should,  as  far  as  possble,  be  assigned  specific  duties  at 
the  galley  in  order  that  the  responsibility  for  any  neglect  may  readily  be  placed. 
One  should  be  detailed  as  "meat  cook,"  another  as  "vegetable  cook,"  and  one  man 
should,  in  addition  to  other  duties,  be  held  responsible  for  the  preparation  of  the 
coffee  and  tea. 

27.  The  cooks  in  the  lower  ratings  should  be  detailed  for  starting  fires,  clean- 
ing the  galley  and  utensils  (regular  cleaning  stations  being  assigned  them)  and 
for  preparing  the  food  for  cooking. 

28.  The  organization  of  the  force  at  the  galley  should  be  as  complete  and 
efficient  as  that  of  a  gun  division. 

The  Bakers. — 29.  The  commissary  steward  should  issue  to  the  baker  such 
quantities  of  flour  and  other  ingredients  as  may  be  necessary  for  making  bread 
for  the  mess  and  keep  him  advised  of  the  amount  of  bread  required  from  day  to 
day. 

30.  The  baker,  or,  in  ships  which  are  allowed  two  bakers,  the  baker  first  class, 
is  to  be  held  responsible  for  the  proper  baking  of  the  bread  and  for  its  delivery  to 
the  messmen  at  the  appointed  times.  He  is  also  responsible  for  the  condition  of 
the  bake  ovens  and  the  utensils  used  by  him. 

PART  II.     THE   COMMISSARY   STORE 

Establishment  and  Administration. — 31.  There  being  no  public  funds  avail- 
able for  the  establishment  of  a  store  on  board  ships  of  the  Navy,  such  establish- 
ment is  not  made  compulsory,  but  is  left  to  the  discretion  of  the  commanding 
officer.  The  advantages  of  such  a  store  are,  however,  so  obvious  and  so  great  that 
provision  is  made  in  the  regulations  for  its  administration  in  ships  where  it 
exists,  or  may  be  established. 

32.  The  objects  of  a  commissary'  store  are: 

(1)  To  enable  the  men  to  purchase  a  better  quality  of  the  articles 

usually  obtained  from  bumboat  men,  and,  at  a  lower  price. 

(2)  To  return  directly  to  the  men  all  profits  from  their  purchases  not 

needed  for  carrying  on  the  business. 

(3)  To  bring   under  official   control   the  sale  of  all  merchandise   on 

board  ship,  and  thus  do  away  with  bumboat  men  and  peddlers, 
and  reduce  the  chances  of  liquor  or  other  unauthorized  articles 
being  brought  on  board.  The  sale  of  any  merchandise  on  board 
ship,  except  by  the  store,  should  be  prohibited  as  far  as  prac- 
ticable. Tailors,  persons  doing  repairing,  and  those  selling  spe- 
cial articles  which  cannot  conveniently  be  handled  by  the  store, 
may  be  exempt  from  this  prohibition,  but  dealers  in  milk,  pies, 
fruit,  and  such  articles  should  not  be  allowed  to  sell  to  the  men. 

33.  The  commissary  should  make  agreement  with  reliable  merchants  to  sup- 
ply to  the  store,  while  the  ship  is  in  port,  such  stores  as  are  salable  but  cannot 
be  carried  in  stock,  and  these  articles  should  be  delivered  to  the  storekeeper  and 


NAVY    RATIONS  735 

by  him  sold  to  the  men  at  a  very  small  advance.  For  example,  if  it  be  thought 
advisable  to  have  milk  for  sale  in  the  store  when  the  ship  is  in  port,  the  commis- 
sary should  arrange  with  a  dealer  to  place  on  board,  at  a  specified  time  each  day, 
a  quantity  of  milk  at  a  fixed  price,  such  quantity  as  may  be  sold  to  be  paid  for, 
and  the  balance  to  be  taken  away  by  the  dealer. 

34.  The  stock  being  purchased  from  reliable  firms  at  wholesale  prices,  will  be 
better  in  quality  and  lower  in  price  than  that  usually  carried  by  bumboats  or 
itinerant  merchants.  The  greater  part  of  the  retail  dealer's  profit  should  revert 
directly  to  the  purchaser  at  the  time  he  buys  the  article — that  is,  the  price  charged 
should  be  very  little,  if  any,  above  the  wholesale  price.  Such  small  profits  as 
may  from  time  to  time  accrue  shall  be  expended  by  the  pay  officer  in  such  man- 
ner as  the  commanding  officer  deems  most  conducive  to  the  pleasure  and  comfort 
of  the  enlisted  men.  No  part  of  those  profits,  however,  is  under  any  circumstances 
to  be  transferred  to  the  general  mess  for  the  purpose  of  supplementing  the 
authorized  ration. 

35.  In  ships  where  the  men  desire  to  subscribe  for  the  original  stock  of  a 
commissary  store,  and  the  commanding  officer  authorizes  its  establishment,  the 
commissary  is,  by  the  regulations,  placed  in  charge  of  it.  This  officer  is  to  re- 
ceive voluntary  subscriptions  from  the  crew,  giving  them  receipts  (stated  to  be 
not  negotiable)  for  the  amount  subscribed,  with  the  agreement  that  these  receipts 
may  be  surrendered  and  the  amount  of  the  subscription  refunded  after  the 
original  stock  has  been  paid  for  and  the  business  is  on  a  good  financial  basis. 
The  original  subscribers,  after  they  have  been  paid  the  amount  of  their  subscrip- 
tions, have  no  further  claim  upon,  nor  interest  in,  the  store. 

36.  During  this  period  it  is  advisable  to  make  the  prices  correspond  with 
those  of  retail  dealers  in  order  that  the  store  may  be  independent  as  soon  as  possi- 
ble, but  when  all  indebtedness  has  been  discharged  and  the  store  is  self-support- 
ing, the  profits  should  be  reduced  to  a  minimum,  it  being  always  borne  in  mind 
that  making  money  is  not  one  of  the  objects  of  the  store.  The  injustice  of  mak- 
ing profits  from  sales  to  one  set  of  men  to  be  divided  among  another  set  at  the 
expiration  of  a  cruise  is  manifest,  and  for  this  reason  the  regulations  provide 
that  such  profits  be  used  to  improve  the  bill  of  fare  of  the  general  mess,  but 
with  the  present  ample  ration  no  addition  to  the  mess  fund  should  be  necessary; 
and  by  reduction  in  prices  from  time  to  time,  as  experience  dictates,  the  monthly 
surplus  should  be  reduced  to  a  minimum,  thus  disposing  of  the  regular  retail 
dealer's  profit  in  the  most  equitable  manner  possible,  i.e.,  by  giving  the  benefit 
of  it  to  each  purchaser  in  the  form  of  a  discount. 

37.  It  is  impracticable  to  operate  a  store  unless  a  suitable  room,  used  for 
no  other  purpose  and  to  which  only  the  storekeeper  has  access,  is  available  for  the 
purpose. 

38.  The  commissary  of  the  ship  has  charge  of  the  ship's  store.  He  is  allowed 
the  services  of  a  yeoman  for  duty  as  storekeeper.  The  commissary  should  give  his 
personal  attention  to  the  purchase  of  stock  for  the  store,  should  fix  the  prices  at 
which  the  articles  are  sold,  establish  a  businesslike  system  for  the  operation  of 


736  ARMY    AND    XAVY    RATIONS 

the  store,  and  direct  all  its  affairs.    He  shall  keep  the  cash  account  and  cause  the 
storeman  to  turn  in  daily  all  money  not  required  for  making  change. 

39.  AU  the  accounts  of  the  commissary  store  should  be  kept  in  such  manner 
as  to  admit  of  ready  inspection  by  the  general  inspector  of  the  pay  corps,  the 
paymaster  of  the  fleet,  or  by  the  board  appointed  for  that  purpose. 

40.  The  storekeeper  should  be  responsible  to  the  commissary  for  the  proper 
conduct  of  the  store.  He  is  to  keep  the  account  of  the  stock,  and  of  the  sales,  and 
submit  to  the  commissary  from  time  to  time  lists  of  articles  required. 

41.  In  order  to  protect  the  store  from  any  loss,  either  through  carelessness  or 
dishonesty,  the  following  method  of  keeping  the  accounts  should  be  employed: 

At  the  end  of  each  month  an  account  of  stock  should  be  taken,  and  the  arti- 
cles found  to  be  on  hand  entered  in  a  book  similar  to  the  return  of  clothing  and 
small  stores.  (This  blank  may  conveniently  be  used  for  the  purpose,  the  head- 
ings of  the  columns  being  changed.)  These  quantities  represent  the  stock  on  hand 
at  the  beginning  of  the  new  month  and  to  them  should  be  added  all  stores 
received  from  purchase.  At  the  end  of  the  month  the  quantities  found  to  be  on 
hand  should  be  entered  in  the  proper  line  and  subtracted  from  the  total  receipts 
and  the  difference  entered  as  "sales."  By  multiplying  the  number  of  each  article 
sold  by  its  selling  price  and  taking  the  total  of  that  line  in  the  ■  return  will  be 
found  the  amount  which  the  storekeeper  should  have  received,  and  this  amount 
he  should  be  required  to  turn  in  or  account  for. 

42.  If  no  prices  are  changed  except  at  the  beginning  of  a  month,  and  if  the 
established  prices  are  displayed  on  the  store  bulletin  board  so  that  no  over- 
charges can  be  made,  this  system  will  be  a  simple  and  absolute  check  on  the 
storekeeper. 

43.  The  man  selected  for  this  responsible  duty  should  first  of  all  be  entirely 
trustworthy.  He  must  be  quick  and  accurate  at  figures  and  write  legibly.  It  is 
his  duty  to  receive  such  stock  as  may  be  delivered  for  the  store,  conveniently 
arrange  it  in  the  storeroom,  and  keep  the  latter  clean  and  see  that  it  is  ready  for 
inspection  at  the  appointed  time.  He  is  to  open  the  store  for  the  sale  of  mer- 
chandise to  the  men  at  such  times  as  may  be  appointed  by  the  commissary,  with 
the  authority  of  the  captain.  He  should  keep  a  small  memorandum  book  in 
which  to  enter  the  amounts  turned  in  daily  to  the  commissary,  and  when  that 
oflficer  receives  the  money,  he  should  initial  the  amount  in  the  book. 


PART   III.     THE   PREPARATION   OF   FOOD 

The  Ration. — 44.  The  dietary  of  the  enhsted  men  of  the  Navy  must  neces- 
sarily be  based  upon  the  ration  provided  by  law.  In  general  messes,  where  the 
circumstances  are  favorable,  provisions  which  are  not  a  part  of  the  ration  may 
at  times  be  purchased,  but  articles  of  which  there  is  a  supply  already  on  board 
in  the  pay  department  should  not  be  bought  unless  the  government  stores  shall 
have  deteriorated,  in  which  case  they  should  be  surveyed  and  a  new  stock 
obtained  at  the  first  opportunity. 


NAVY   RATIONS  737 

45,  Unless  there  be  some  good  reason  for  not  doing  so,  the  official  issuing 
table  should  be  strictly  adhered  to,  it  having  been  arranged  to  give  the  necessary 
variety. 

The  Galley. — 46.  The  ship's  galley  (or  that  part  of  it  used  by  the  general 
mess),  together  with  its  appurtenances,  is  under  the  charge  of  the  commissary. 
That  officer  should  see  that  the  galley  and  its  utensils  are  properly  cared  for  and 
are  ready  for  inspection  at  tlie  appointed  times.  He  should  himself  frequently 
inspect  this  part  of  his  department  and  advise  the  equipment  officer  of  any  re- 
pairs or  alterations  needed,  and  should,  when  occasion  demands  it,  furnish  that 
officer  with  a  list  of  galley  utensils  requiring  a  survey. 

Cooking. — i7.  On  board  ship,  where  the  facilities  are  necessarily  restricted 
and  the  food  lacking  in  variety  compared  to  that  obtainable  on  shore,  it  is  of  the 
highest  importance  that  the  very  best  results  possible  under  the  circumstances 
should  be  obtained.  With  a  hberal  allowance  of  cooks  and  bakers,  and  a  judi- 
cious selection  of  the  men  for  these  rates,  the  Navy  ration  should  be  so  prepared 
as  to  give  the  enlisted  men  three  nourishing  and  palatable  meals  each  day,  and 
it  should  be  the  duty  of  the  commissary  department  to  see  that  this  is  done. 
Frequent  inspections  of  the  food  by  the  commissary  and  the  commissary  steward, 
and  efficiency  on  the  part  of  the  cooks  alone  can  insure  this. 

REFERENCES 

1.  Woodruff,  Maj.  Chas.  E.     J.  Am.  M.  Assn.,  Dec.  3,  1892,  p.  651. 

2.  U.  S.  Army  Regulation,  1913,  par.  1202. 

3.  War  Dept.,  Edition  of  1913,  par.  1205,  General  Orders,  No.  15; 

War  Dept.,  1913,  Bull.  28. 

4.  Harvard,  Col.  Valrey.    Military  Hygiene,  Wm.  Wood  and  Co. 

5.  War  Dept.,  Bull.  No.  21,  Executive  Order,  May  28,  1914,  William 

Wood  and  Co. 
G.     MuNSON,  Ed.  L.     Boston  Med.  &  Surg.  J.,  May  24,  1900. 

7.  Gephart.     In  the  Laboratory  of  the  Russell   Sage  Institute  of 

Pathology,  Ed.  J.  A.  M.  A. 
Davis.     Food  in  Health  and  Disease,  p.  62. 

8.  LusK,  Graham.     "Food  Economics,"  J.  Washington  Acad.  Sci.,  vol. 

6,  p.  340,  1916. 

9.  Woodruff,  Maj.  Chas.  E.     Med.  Rec.,  May  20,  1899. 

10.  Woodruff,  Major.     Med.  Rec.,  N.  Y.,  May,  1899,  p.  701. 

11.  Fauntleroy,  a.  M.     Med.  Corps,  U.  S.  N.  Medico-Military  As- 

pects of  the  European  War,  Bureau  of  Med.  and  Surg.,  Navy 
Dept. 

12.  Caldwell,  W.  B.     Mil.  Surgeon,  March,  1916,  vol.  38,  No.  3. 

13.  TsuL     Mil.  Surgeon,  Nov.,  1909. 

14.  Fitch,  W.  E.,  Maj.  M.  R.  C,  Military  Surgeon,  May,  1917. 


CHAPTER   XIX 


FOOD  ECONOMICS  IN  WAR 

Food  Situations  in  Countries  at  War:  Germany,  Great  Britain. 

Use  of  Certain  Foodstuffs  in  War:  Bread  and  Cereal  Foods;  Milk,  Sugar; 

Alcohol  in  War  Economies;  the  Food  Situation  in  the  United  States. 
Summary. 

Out  of  evil  good  may  come,  and,  of  course,  this  saying  is  as  true  of 
war  as  of  any  evil  thing.  So  far  as  the  food  question  is  concerned,  many 
valuable  lessons  have  been  learned  with  respect  to  food  values,  and  al- 
though at  the  time  of  writing,  the  war  is  still  in  progress,  with  no  signs 
of  a  speedy  end,  it  has  been  felt  by  the  author  that  a  work  on  diet  written 
at  such  a  period  would  not  be  complete  unless  the  matter  of  feeding 
populations  shut  off  from  most  or  many  of  their  ordinary  sources  of  sup- 
ply was  at  least  discussed.  Perhaps  no  really  definite  lessons  as  to  food 
can  be  learned  until  the  conflict  is  over,  but,  on  the  other  hand,  a  good 
deal  of  valuable  information  has  already  been  collected,  and  some  of  the 
facts  brought  out  should  not  be  passed  over. 

For  example,  it  has  been  proved  beyond  peradventure  that  not  only 
can  the  physical  equilibrium  be  maintained  without  luxuries — this  was 
known  before — but  that,  if  a  diet  is  well  balanced,  the  energy  and  heat 
necessary  to  keep  the  human  machine  in  good  working  order  can  be  pro- 
vided by  a  quantity  considerably  less  than  would  have  been  considered 
adequate  in  the  piping  days  of  peace.  The  lesson  has  been  fairly  well 
learned  by  the  inhabitants  of  some  of  the  countries  at  war  that  food  can 
be  reduced  to  the  exact  requirements  of  the  human  machine,  with  much 
benefit  to  the  smooth  working  of  that  machine.  The  members  of  the  med- 
ical profession  have  long  preached — and  their  preaching  has  been  as  the 
voice  of  one  crying  in  the  wilderness — the  doctrine  of  self-control  in  the 
matter  of  food.  The  evils  of  gluttony  or  of  eating  to  excess  have  been 
enlarged  on  in  Volume  II,  Chapter  VI,  and  the  fact  that  governments, 
for  the  purpose  of  high  politics,  have  had  to  step  in  to  heal,  in  spite  of 

739 


740  FOOD    ECONOMICS    IN    WAR 

themselves,  many  unsuspected  victims  of  gluttony/  possesses  a  decidedly 
ironical  aspect.  The  experience  of  the  war  has  proven,  once  and  for  all 
time,  that  the  majority  of  well-to-do  persons  persistently  eat  more  than 
is  good  for  health,  and  has  clearly  demonstrated  that  the  diet  to  which 
an  individual  has  become  addicted  by  custom,  and  which  he  has  brought 
himself  to  believe  the  most  nutritious,  is  often  surpassed  by  articles  of 
diet  which  he  has  been  wont  to  despise  as  cheap  and  lacking  in  strength 
and  energy-giving  properties. 

FOOD   SITUATIONS  IN   COUNTRIES   AT   WAR 

Germany. — The  European  war  afforded  an  unique  opportunity, 
though  an  unsought  one,  to  study  the  relation  of  the  food  supply  to  un- 
expected economic  and  territorial  conditions.  In  Germany,  in  particular, 
the  situation  was  unparalleled  owing  to  the  exclusion  of  the  greater  part 
of  the  food  which  in  normal  times  was  efet^ined  from  abroad.  Germany 
had  been  in  the  custom  of  procuring  most/iOf  .her  wheat,  rice  and  other 
foods  from  Russia.  This  source  of  supply  was  completely  cut  off.  From 
the  Scandinavian  countries  she  had  obtained  a  large  proportion  of  butter, 
eggs  and  lard,  and  from  America  both  foods  and  crude  materials  which 
were  applied  to  animal  production.  With  all  these  external  sources  of 
supply  threatened  or  wholly  cut  off,  the  question  presented  itself,  how 
were  the  inhabitants,  civil  and  military,  to  be  fed,  relying,  perhaps, 
mainly  on  internal  resources. 

With  the  organizing  ability  and  scientific  acumen  with  which  the 
Germans  have  long  been  credited,  their  professors  and  business  men  pro- 
ceeded to  attack  the  problem,  and  in  the  early  days  of  the  war  Dr.  Paul 
Eltzbacher,  acting  Rector  of  the  Berlin  High  School,  edited  a  pamphlet 
in  which  leading  experts  discussed  the  problems  of  the  food  supply  in 
Germany  and  the  means  to  be  taken  for  assuring  adequate  provision  for 
all  the  inhabitants.  According  to  this  pamphlet,  the  export  of  native 
products,  such  as  sugar  and  rice,  was  to  be  restricted ;  the  feeding  of  ma- 
terials suitable  for  human  consumption  to  cattle  was  to  be  greatly  de- 
creased. Conservation  of  food  values  ordinarily  lost  in  the  processes  of 
conversion  into  animal  tissue  was  to  be  brought  about ;  unjustifiable  waste 
was  to  be  avoided  not  only  on  a  large  scale  but  even  in  the  individual 
kitchen.  The  minuteness  and  the  elaborate  nature  of  the  study  were 
indicated  by  such  details  as  reminders  that  twenty  grams  of  fat  per  capita 


1  The  evils  of  gluttony  or  of  eating  to  excess  have  been  enlarged  upon  in  Chapter 
VI  of  this  volume. 


FOOD    SITUATIONS    IN    COUNTRIES    AT    WAR       741 

were  lost  in  the  sewage  waste  of  Berlin  every  day,  and  that  this  ought  to 
be  prevented. 

The  inhabitants,  on  the  authority  of  well-known  scientific  men,  were 
assured  that  changes  of  dietary  regimen  intelligently  carried  out  need 
cause  no  alarm,  as  the  public  health  would  not  suffer  thereby.  Pamphlets 
were  widely  distributed  in  which  the  laws  governing  nutrition  were  pro- 
claimed and  suitable  dietetic  advice  was  given.  It  was  urged  that  plant 
products,  rich  in  carbohydrates,  should  be  more  liberally  used  and  that 
the  consumption  of  meat,  rich  in  proteins  and  fats,  should  be  restricted. 
The  substitution  of  the  regimen  of  South  German  households  in  the  place 
of  the  excessive  meat  diet  of  the  northern  provinces  was  strongly  recom- 
mended. Even  a  cook  book  for  war  time  was  freely  distributed,  and  the 
services  of  German  chemists  were  requisitioned  to  supply  by  the  aid  of 
their  science  substitutes  for  some  of  the  lacking  food  products. 

Another  pamphlet  was  issued  in  the  early  part  of  1916,  the  authors 
of  which  were  Professors  Kuczynski  and  Zuntz  of  Berlin.  On  Jan.  25, 
1915,  the  German  government  took  the  supplies  of  wheat  and  rye  into 
its  own  hands  and  decreed  that  those  engaged  in  agriculture  should  have 
an  allowance  of  7.2  kilograms  of  flour  per  month  per  head,  and  the  rest 
of  the  population  225  grams  daily  per  head.  In  February,  the  allow- 
ance of  225  grams  was  reduced  to  200.  In  time  of  peace  the  average 
consumption  per  head  was  340  grams,  so  that  the  people  as  a  whole  had 
to  deny  themselves  14  per  cent  of  their  accustomed  nourishment,  and  the 
poor,  with  whom  bread  is  a  more  important  item,  25  per  cent. 

For  the  first  six  months  of  the  war,  the  condition  of  the  food  supply 
was  not  less  favorable  than  in  time  of  peace.  Food  prices  had  risen 
steadily,  although  in  many  trades  wages  had  risen  correspondingly.  Later 
on,  as  the  cereal  supply  began  to  run  short  and  a  bread  ration  was  fixed, 
the  poorer  classes  lost  about  20  per  cent  to  25  per  cent  of  their  staple 
diet.  The  price  of  rye  bread  in  January,  1915,  had  risen  33  per  cent, 
and  in  May,  53  per  cent;  while  wheat  bread  had  advanced  26  per  cent 
and  35  per  cent  as  compared  with  prices  in  January,  1914,  and  May, 
1914.  With  other  foods,  prices  had  risen  on  an  average  of  81  per  cent 
from  May,  1914,  to  May,  1915.  This  great  rise  in  prices  forced  the 
mass  of  the  people  to  buy  the  cheaper  kinds  of  foods  and  also  to  buy 
smaller  quantities.  A  great  deal  of  the  difference  was  accounted  for  by 
more  careful  cooking  and  usage,  as  cooking  potatoes  in  their  skins;  but 
in  such  foods  as  meat,  milk,  etc.,  such  a  saving  was  not  possible.  Briefly, 
the  situation  from  February  or  March,  1915,  onwards,  was  one  of  en- 
forced moderation,  with  health-giving  results  to  hundreds  of  thousands 

147 


742 


FOOD    ECOK^OMICS    I:N^    WAR 


of  over-fed  people,  but  implying  for  the  masses  a  weakening  of  their 
working  capacity  by  hardships  which  amounted  to  actual  want. 

The  second  chapter  of  the  Kuczynski  and  Zuntz  pamphlet  dealt  with 
the  right  division  of  food  between  man  and  beast,  into  which  there  is  no 
space  to  enter  at  length.  The  importance  of  sugar  as  a  foodstuff  was 
dwelt  upon,  not  only  as  a  food,  but  as  a  means  of  preserving  large  quan- 
tities of  fruit  and  vegetables. 

The  finding  of  new  fodder,  consequent  upon  the  reservation  for  the 
use  of  man  of  foodstuffs  which  used  to  be  employed  for  animal-feeding 
purposes,  was  a  feature  of  the  situation.  In  the  search  for  new  fodder 
it  was  recommended  that  the  forests  of  leafy  trees  might  supply  nutri- 
ment for  pigs  and  cows.  The  comparative  nutritive  value  of  the  various 
leaves  is  shown  in  the  following  table,  giving  the  amount  of  protein  and 
starch  obtained  from  100  kilograms  of  each  raw  material : 

COMPARATIVE  NUTRITIVE  VALUE  OF  VARIOUS  LEAVES 


Species  of  Fodder 

Digestive  Protein 

Starch 

Elm  leaves  (young) 

Kg. 
11.7 

9.7 
26.6 
11.3 

6.0 

0.9 

6.7 

5.5 

5.5    • 

1.3 

Kg. 
50.0 

"      (old) 

38.8 

Acacia  leaves 

54.0 

Horse-chestnut  leaves 

41.7 

Poplar  leaves  in  October 

26.7 

Copper  beech  leaves  in  August 

Vine  leaves  in  autumn 

16.7 
42.5 

Acacia  brushwood  in  winter 

12.6 

Good  meadow  hay 

31.8 

Oat  straw 

17.4 

In  order  to  make  the  best  possible  use  of  leaves,  it  must  be  borne  in 
mind  that  during  the  day  the  action  of  light  draws  considerable  quanti- 
ties of  starch  and  sugar  into  the  leaves,  some  of  which  returns  during  the 
night  into  the  woody  parts,  so  that  the  leaves  are  of  the  most  nutritive 
value  towards  evening,  when  they  should  be  gathered.  Towards  autumn 
the  leaves  are  less  nutritious  as  well  as  less  digestible,  but,  on  the  other 
hand,  they  contain  less  water  and  are  more  easily  dried.  This  use  of 
leaves  especially  should  meet  the  case  of  the  poorer  people  in  town  and 
country  who  keep  one  cow  or  a  few  goats.  This  is  a  lesson  that  has  been 
learned  from  the  war. 

Haberlandt  was  quoted  by  the  authors  as  having  revealed  another 


FOOD   SITUATIONS    IX    COUNTRIES    AT    WAR       743 

source  of  supply  iu  the  woods,  the  sapwood  of  trees  in  early  spring,  with 
its  high  content  of  starch  and  fat.  To  obtain  nutritive  matter  from  straw 
and  wood,  certain  methods  are  available.  The  most  recent  method  is  the 
use  of  organic  acids  which  are  in  themselves  of  value  as  fodder,  as  lactic 
acid.  The  significance  of  this  method  lies  in  the  fact  that  not  only  is 
much  cellulose  converted  into  digestible  carbohydrate,  but  the  remaining 
nutriment  in  the  cellulose  coverings  is  exposed  at  the  same  time  to  the 
action  of  the  digestive  juices  of  the  animal. 

In  the  search  for  new  fodders,  heather  was  not  overlooked,  especially 
as  it  contains  very  little  water,  and  is  therefore  easy  to  dry.  Of  the 
highest  importance  in  storing  foodstuflt's  is  the  question  of  drying,  not 
only  for  animals,  but  as  a  means  of  preserving  food  in  concentrated  form 
for  man  also.  The  drying  of  turnip  scraps  and  tuniip  leaves,  of  the  leav- 
ings of  the  malt  in  beer  brewing,  of  the  distiller's  and  other  waste  prod- 
ucts from  various  industries,  has  long  been  practiced  to  a  large  extent, 
sometimes  by  means  of  gas,  sometimes  by  steam  heating.  The  hay  crop 
can  be  increased  by  20  per  cent  or  30  per  cent  by  increased  facilities  for 
drying. 

The  following  table  shows  the  percentage  loss  in  nutrient  material 
by  the  tardy  drying  of  hay : 


LOSS  FROM  TARDY  CURING  OF 

HAY 

Time  taken 
for  drying 

Protein 

Fat 

Nitrogen-free 
extractives 

Fiber 

Mineral 

salts 

10  days 
20     « 

9.9 
45.8 

49.5 
72.9 

16.3 
46.6 

2.5 
27.7 

12.8 
48.6 

The  authors  were  of  the  opinion  that  the  drying  process  was  not  only 
useful  for  fodder  but  also  for  foodstuffs.  In  the  household  it  could  be 
done  on  the  hearth,  in  the  oven,  or  in  the  open  air.  Not  only  the  usual 
fruits,  such  as  plums,  apples,  cherries,  bilberries,  etc.,  should  be  pre- 
served by  these  means,  but  also  potatoes,  either  raw  or  in  slices,  or  boiled 
in  their  skins  and  then  mashed.  Further,  since  drying  factories  could 
not  be  built  fast  enough,  pickling  methods  must  be  improved  by  the  em- 
ployment of  the  culture  of  bacilli.  Even  in  the  case  of  withered  turnip 
tops  the  Institute  of  Eermentation  Industries  at  Berlin  found  that  by 
placing  them  in  large  quantities  in  cemented  pits  and  treating  them  with 
a  culture  of  lactic  acid,  loss  by  fermentation  was  considerably  reduced. 


744  FOOD    ECONOMICS    IN    WAK 

Among  the  many  lessons  which  the  war  has  taught  in  the  matter  of 
diet  is  that  when  woman  works  at  manual  labor  in  the  open  air,  cultivat- 
ing the  fields,  for  example,  as  she  has  in  England  and  Germany,  she  needs 
a  ration  liberal  in  proportion  to  the  expenditure  of  energy.  This  was  a 
matter  that  was  somewhat  overlooked  in  the  calculations  as  to  economizing 
the  food  supply. 

Another  important  lesson  that  has  been  learned  is  that  fat  is  a  factor 
of  more  prominence  than  was  generally  believed  in  the  scheme  of  nutri- 
tion. While  fat  formed  a  fair  proportion  of  a  German  diet  in  the  ordi- 
nary way,  the  production  of  fat  has  not  been  encouraged  or  stimulated  by 
the  German  agricultural  system.  As  early  as  the  autumn  of  1915,  in 
addition  to  two  meatless  days  in  the  week,  the  German  regimen  ordered 
the  introduction  of  two  fatless  days.  German  writers  generally,  follow- 
ing Voit,  have  rated  the  desirable  amount  of  fat  in  the  daily  ration  at 
56  grams,  almost  2  ounces  to  100  grams,  for  men  at  hard  manual  labor 
in  the  open  air.  It  has  been  taught  by  them  that  with  increase  in  the 
body's  demand  for  available  food  fuel,  it  is  preferable  not  to  increase  too 
largely  the  carbohydrate  intake,  which  is  usually  put  at  about  500  grams, 
but  rather  to  add  to  the  quota  of  fat  in  about  the  proportion  indicated 
by  the  above  quoted  figures.  It  must  be  borne  in  mind  that  an  increment 
in  fat  can  be  obtained  with  far  less  increase  of  bulk  than  a  comparable 
augmentation  of  carbohydrate-containing  foods  will  permit.  A  gram  of 
fat  yields  more  than  twice  the  energy  that  is  yielded  by  the  same  unit 
weight  of  the  other  available  nutrients. 

Dr.  Alonzo  E.  Taylor,  who  was  in  Germany  during  a  part  of  the  war, 
and  was  afforded  special  facilities  for  studying  the  food  question  at  first 
hand,  gave  the  results  of  his  experiences  and  deductions  drawn  therefrom 
in  a  series  of  exceptionally  able  articles  contributed  to  the  Saturday  Even- 
ing Post  in  the  early  part  of  1917,  from  which  the  author  has  drawn 
largely  in  the  preparation  of  this  section.  He  stated  that  in  1915  the  fat 
intake  in  Germany  was  not  more  than  20  grams,  animal  and  vegetable,  per 
capita  per  day.  While  this  is  certainly  more  than  enough  to  cover  the  needs 
in  fat  soluble  vitamines  and  is  twice  the  intake  of  fat  of  the  Japanese,  the 
fact  remains  that  the  people  were  hungry.  The  consumption  of  fat  in 
Germany  prior  to  the  war  was  about  31/2  ounces  per  capita  per  day,  of 
which  nearly  half  was  obtained  by  importation,  directly  or  indirectly. 
As  the  cultivation  of  fat-producing  materials  had  not  been  encouraged, 
and  as  the  partial  blockade  to  which  Germany  was  subjected  very  greatly 
restricted  the  importation  of  fat  upon  which  the  country  largely  de- 
pended for  its  supply,  the  inhabitants  had  to  go  without  a  good  deal  of 


FOOD    SITUATIONS    11^    COU:NrTRIES    AT    WAR       745 

the  fatty  ingredients  of  diet  to  which  they  were  accustomed.     Fat  being  a 
fertile  source  of  energy,  they  suffered  much  from  this  deprivation. 

The  following  table  culled  from  Taylor's  paper  (1)  contains  the  esti- 
mates of  four  different  calculations  as  stated  for  protein,  fat,  carbohydrate 
and  calories  per  head  per  day  of  the  food  consumption  of  Germany  based 
on  official  data  for  the  years  1912  and  1913. 

CONSUMPTION  OF  FOOD  UNITS  IN  GERMANY,  1912-1913 


Total 

Imported 

Domestic 

Observer 

1 

Ah 

s 

St 

1 

IS 

P3 

1 

o 

1 

s 

f^ 

O 

Is 
O 

Ballod 

oz. 

3.10 

3.30 

3.70 

3.25 

oz. 

2.15 

3.75 

3.11 

2.33 

oz. 

14.5 

18.7 

20.1 

16.0 

2,708 
3,642 
3,550 
2,790 

oz. 

0.85 

0.90 

1.13 

0.90 

oz. 

0.88 

1.60 

1.06 

1.06 

oz. 
0.8 
1.5 
1.4 
1.4 

450 
715 
473 
550 

oz. 

2.25 

2.40 

2.57 

2.35 

oz. 

1.30 

2.10 

2.05 

1.27 

oz. 

13.5 

17.2 

18.7 

14.6 

2,480 
2,927 
3,077 
2,204 

Eltzbacher 

Kuczynski  and  Zuntz. 
Taylor 

In  the  Eltzbacher  report  the  German  population  was  put  down  as 
68,000,000.  The  number  of  children  of  each  year  and  the  number  of 
adult  males  and  females  were  known.  The  figure  for  the  number  of 
children  of  each  year  of  age  was  multiplied  by  the  figure  for  the  food 
need  of  that  year.  The  number  of  adult  females  and  the  number  of 
adult  males  were  multiplied  respectively  by  85  and  100.  The  final  figure 
for  the  needed  food  units,  a  compromise  between  several  standards,  was 
51,822,908. 

This  means  that  the  population  of  68,000,000  would  be  nourished  if 
it  received  the  ration  of  51,822,908  adults.  Three  thousand  calories  was 
the  figure  set  for  the  adult  need.  The  caloric  needs  of  the  German  people 
were,  therefore,  determined  by  the  simple  multiplication — 3,000  x  365  x 
51,822,908  =  56,750,000,000,000  calories.  When  this  figure  for  total 
calories,  determined  on  the  basis  of  man  ration,  was  divided  by  the  figure 
for  the  population,  the  re^ilt  was  2,280  calories  a  day.  The  protein  needs 
of  the  people  were  also  calculated.  Children  under  six  years  of  age  were 
allotted  1.4  ounces  a  day ;  from  six  to  twelve,  about  1.75 ;  from  twelve  to 
eighteen,  about  2.3.  Adult  men  were  allotted  2.9  ounces;  adult  women, 
2.4. 

Taylor,  taking  into  consideration  that  all  work  harder  in  war  time, 
especially  women,  and  further  considering  that  the  estimate  for  children 


746 


FOOD   ECONOMICS    IN    WAR 


from  12  to  18  was  too  low,  calculated  the  protein  and  caloric  needs  of  the 
German  people  in  war  time  as  follows:  protein,  1,524,000  tons;  calories, 
63,000,000,000,000. 

The  protein  needs  as  set  forth  by  figures  supplied  by  Eltzbacher,  Tay- 
lor and  Chittenden  are  as  follows: 


PROTEIN  NEEDS  IN  OUNCES 

Per  Capita 

Man  Ration 

Eltzbacher 

2.30  oz. 
2.15  war-time 
1.5 

2.83  oz. 

Taylor 

2.5      " 

Chittenden 

1.8     " 

CALORIC  NEEDS 


Eltzbacher. 

Taylor 

Chittenden 


Per  Capita 


2,380  peace-time 
2,510  war-time 
2,030 


Man  Ration 


3,000 
3,300 
2,600 


The  peace-time  consumption  of  protein  in  Germany,  according  to  the 
Chittenden  standard,  was  50  per  cent  in  excess  of  requirements,  and  the 
domestic  production  of  protein  was  just  large  enough  to  cover  the  need. 
It  seemed  also  apparent  from  the  data  that  the  fat  consumption  in  peace- 
time was  too  large,  and  that  the  fat  of  domestic  origin  should  be  enough 
to  satisfy  normal  requirements.  Consequently,  it  appeared  evident  to  the 
German  scientists,  at  any  rate,  that  if  the  German  people  would  reduce 
their  consumption  to  the  plane  of  physiological  needs,  that  is,  physiolog- 
ical needs  chiefly  computed  by  means  of  laboratory  experiments,  and 
maintain  the  domestic  production  on  the  peace-time  basis,  they  would 
not  experience  much  harm  by  a  blockade. 

When  one  compares  what  has  been  achieved  in  production  with  what 
the  commission  of  German  scientists  believed  could  be  attained,  the  re- 
sults are  not  creditable  to  the  agricultural  classes,  even  when  the  influ- 
ences of  unfavorable  weather  are  fully  allowed  for.  The  Eltzbacher 
Commission  made  the  following  estimates:  (a)  peace-time  use:  protein, 
2,261,000  tons,  and  calories,  88,694,000,000,000,  including  protein  of 
domestic  origin,  1,650,000  tons,  and  calories,  71,282,000,000,000.  (h) 
physiological  need:  protein,  1,605,000  tons;  calories,  56,750,000,000,000. 
(c)  attainable  production  under  hlocJcade:  protein,  2,022,000  tons;  calo- 
ries, 81,250,000,000,000.      Actual  production  in  1914-15  in  foodstuffs 


POOD    SITUATI0:N^IS    IX    COUNTlilES    AT    WAR       747 

was:  protein,  1,510,000  tons;  calories,  63,410,000,000,000.  Actual  pro- 
duction in  1915-16  was;  protein,  1,100,000  tons;  calories,  57,000,000,- 
000,000. 

The  dietary  of  the  industrial  classes  of  Germany  was  from  March  to 
September,  1916,  reduced  to  the  physiological  minimum.  This  diet  was 
low  in  animal  protein,  very  low  in  fat,  and  low  in  calories,  and  when  the 
work  that  had  to  be  done  was  considered,  manifestly  insufficient.  A  sur- 
vey of  the  chief  manufacturing  cities  of  the  empire  carried  out  during 
the  late  months  of  1916  indicated  that  the  average  intake  for  adults  varied 
from  1.6  to  2  ounces  of  protein  and  from  1,800  to  2,500  calories  per  day. 
As  Taylor  remarked,  since  this  was  not  sufficient  to  maintain  the  physical 
labor  that  was  being  done,  this  was  accomplished  by  utilization  of  the 
body  fat  of  the  workers. 

Food  Situation  in  Great  Britain. — It  was  not  until  the  early  part  of  the 
year  1917  that  the  British  Government  took  any  very  definite  steps  lead- 
ing to  a  control  of  the  food  supply,  though  a  ban  had  been  placed  on  some 
articles  of  food  and,  of  course,  advice  had  been  given  as  to  the  need  for 
economy  of  food  and  warning  against  waste  had  been  freely  tendered. 
The  report  on  the  food  supply  of  the  United  Kingdom,  drawn  up  by  a 
committee  of  the  Royal  Society,  was  published  in  the  first  week  of  Feb- 
ruary, 1917,  and  provided  some  very  interesting  information.  The  first 
part  contained  an  estimate  of  the  annual  food  supply  of  Great  Britain,  im- 
ported and  home-produced,  in  the  period  before  the  war,  1909-1913. 

It  may  be  said  here  that,  according  to  Taylor (2),  in  the  year  before 
the  war,  about  13,750,000  tons  of  foodstuffs  and  feeding  stuffs  were  im- 
ported into  the  United  Kingdom,  nearly  ten  millions  of  which  were  food- 
stuffs. It  was  not  possible*  to  give  more  than  approximate  figures,  since 
there  was  overlapping,  as,  for  example,  between  food  fat  and  industrial 
fat.  The  total  food  consumption  for  Great  Britain  was  probably  about 
twenty  million  tons.  To  make  the  gross  figure  for  importation  of  food- 
stuff more  concrete,  it  may  be  stated  that  in  1914  the  importation  per 
capita  was:  wheat,  250  pounds;  flour,  23.9  pounds;  potatoes,  8  pounds; 
sugar,  80  pounds;  rice,  14.2  pounds;  ham  and  bacon,  14.2  pounds;  beef, 
20  pounds;  mutton,  12.4  pounds;  other  meats,  8.4  pounds;  butter,  9.46 
pounds ;  cheese,  5.75  pounds,  and  eggs,  46  per  head. 

To  turn  again  to  the  Committee's  report,  it  is  there  stated  that,  after 
consideration  of  the  dietary  requirements  of  a  nation  for  the  most  part 
engaged  in  active  work,  the  Committee  was  convinced  that  they  could  not 
be  met  satisfactorily  on  a  less  supply  in  the  food  than  100  grams  pro- 
tein, 100  grams  fat,  and  500  grams  carbohydrates,  yielding  approximately 


748  FOOD    ECONOMICS    IN    WAR 

3,400  calories  per  man  per  day,  a  "man"  being  an  average  workman  doing 
an  average  day's  work.  The  Committee  adopted  this  as  the  minimum 
standard.  Generally  speaking,  a  woman  or  child  requires  less  food  than 
a  man,  and  to  convert  the  population  of  men,  women  and  children  into 
units,  or  "men,"  as  defined  above,  the  total  number  must  be  reduced  by 
23  per  cent.  In  reckoning  diet,  100  men,  women  and  children  equal  77 
units,  that  is  to  say,  men. 

The  total  quantities  of  foodstuffs  available  during  the  period  1909-13 
provided  4,009  calories  per  "man."  There  had  been  a  certain  margin, 
and  the  Committee  calculated,  taking  the  minimum  physiological  stand- 
ard mentioned  above,  that  there  had  been  either  wasted,  or  consumed  in 
excess  of  requirements,  of  proteins  11  to  14  per  cent,  of  fats  25  to  30  per 
cent,  of  carbohydrates  10  to  14  per  cent.  It  should  be  noted  that  the  fig- 
ures for  quantities  of  food  are  for  weights  as  purchased,  no  attempt  hav- 
ing been  made  for  loss  during  distribution,  nor  for  digestibility. 

The  second  part  of  the  report  dealt  with  the  food  supply  in  1916. 
The  Committee  stated  that  down  to  the  end  of  July  in  that  year,  the 
supply  of  food  had  provided  a  general  margin  of  about  5  per  cent  above 
the  minimum  necessary  for  proper  nutrition  and  rather  more  as  regards 
the  supply  of  energy,  so  that  a  reduction  to  this  extent  would  still  furnish 
amounts  of  the  essential  food  constituents  conforming  to  the  standard 
adopted.  Such  a  reduction  could  be  borne  without  serious  injury  to  the 
community,  provided  steps  were  taken  to  ensure  the  equitable  distribu- 
tion of  the  available  food  throughout  the  population.  Speaking  as  physi- 
ologists, the  members  of  the  Committee  laid  stress  on  the  fact  that  in  buy- 
ing food  the  laboring  population  was  buying  energy.  If  rising  prices 
curtailed  for  any  class  of  the  community  its  accustomed  supply  of  food, 
its  output  of  work  would  of  necessity  be  reduced,  and  it  was  important 
to  remember  that  a  slight  reduction  of  food  below  the  necessary  amount 
caused  a  large  diminution  in  the  working  efficiency  of  the  individual. 

In  an  appendix  to  the  report,  some  particulars  were  given  of  army 
rations.  The  weekly  rations  issued  to  the  army  at  home  in  England  were 
as  follows:  beef,  84  ounces;  bacon,  14  ounces;  bread,  112  ounces;  sugar, 
14  ounces,  and  in  addition,  the  men  were  in  the  habit  of  purchasing  vari- 
ous articles  of  food  from  a  long  list  yielding  on  an  average  1,510  calories 
a  day,  giving  a  total  energy  value  for  the  diet  of  a  man  in  the  British 
home  army  of  4,031  calories  a  day.  The  civil  population  at  a  similar 
rate,  but  with  a  reduction  of  23  per  cent  for  women  and  children,  would 
be  entitled  to  a  diet  yielding  an  energy  value  of  about  2,667  calories  a 
day. 


FOOD    SITUATIONS    IN    COUNTEIES    AT    WAR       749 

The  following  are  figures  estimating  the  food  consumption  of  Great 
Britain  during  the  first  year  of  the  war  compiled  by  a  German  statisti- 
cian, Ballod,  a  British  physiologist,  Thompson,  and  Dp.  Alonzo  E. 
Taylor.      . 

FOOD  CONSUMPTION  PER  HEAD  PER  DAY  IN  UNITED  KINGDOM 


Protein 

Fat 

Carbohydrate 

Calories 

Thompson 

2.70  oz. 
3.75  " 
3.25  " 

3.60  oz. 
2.58  " 
3.18  " 

15.5  oz. 

15.6  " 
15.1  " 

3,100 
2,900 
3  000 

Ballod 

Taylor 

According  to  Thompson  for  Great  Britain,  and  the  Eltzbacher  Com- 
mission for  Germany,  the  subsistence  of  one  hundred  inhabitants  would 
be  about  covered  by  the  food  required  by  seventy-five  adult  males,  and  the 
man  rations  of  the  three  estimations  would  be  as  follows,  in  ounces  and 
calories : 

FOOD  REQUIRED 


Protein 

Fat 

Carbohydrate 

Calories 

Thompson 

3.59 

5.0 

4.38 

4.81 
3.45 
4.24 

20.7 
20.8 
20.1 

4,130 
3,860 
4,000 

Ballod 

Taylor 

The  caloric  need  of  the  adult  man  was  put  by  the  Eltzbacher  Com- 
mission at  3,000  calories,  somewhat  low  for  the  extraordinary  work  of 
war  time,  lower  by  400  calories  than  that  set  as  a  minimum  by  the  Com- 
mittee of  the  Royal  Society  of  Great  Britain.  However,  reckoning  it  at 
this  figure,  40,240,000,000,000  calories  would  be  required  to  maintain 
the  bodily  heat  and  energy  of  the  45,370,000  inhabitants  of  the  British 
Isles  for  a  year. 

The  protein  requirements  calculated  in  similar  fashion,  on  the  com- 
putation of  the  Eltzbacher  Commission,  80  grams  per  day  for  an  adult 
man,  would  work  out  at  1,130,000  metric  tons.  The  British  Committee 
considered  that  the  minimum  protein  requirement  for  an  adult  man  was 
100  grams,  while  Chittenden  and  other  physiologists  have  contended  that 
this  amount  could  be  greatly  reduced  without  injury  to  the  public  health. 
The  German  experience  during  the  war  seems  to  lend  some  support  to  the 
view  that  Chittenden  and  his  followers  were  correct,  but  until  more  is 


750  FOOD    ECONOMICS    IN    WAR 

known  concerning  conditions  in  Germany  than  is  known  at  the  time  of 
writing,  it  will  not  be  discreet  to  be  dogmatic  on  this  point.  There  is  lit- 
tle doubt  that  the  Germans  concealed  the  true  state  of  affairs  to  a  large 
extent.  Probably  much  more  food  was  imported  than  was  believed,  and 
also  it  is  not  unlikely  that  the  condition  of  their  industrial  classes  was 
worse  than  it  was  credited  to  have  been.  Little  bad  news  was  allowed  to 
leak  out,  and  it  must  be  borne  in  mind  that  the  main — almost  sole — object 
of  the  German  rulers  was  to  feed  their  army  and  workers  directly  con- 
nected with  military  supplies  and  to  pay  much  less  attention  to  the  other 
members  of  the  community.  The  fact  must  also  be  taken  into  considera- 
tion with  respect  to  protein  ingestion  that  the  British  have  always  been 
heavy  meat  eaters,  and  that  inherited  and  ingrained  habits  count  for  a 
good  deal  when  the, nutritive  value  of  a  diet  is  concerned. 

Nevertheless,  we  will  take  it  for  granted  that  the  British  consumption 
of  protein  was  larger  than  physiological  requirements.  Taking  the  physi- 
ological requirements  of  protein  daily  for  an  adult  man  at  eighty  grams 
a  day  and  the  caloric  need  at  3,000  calories,  the  amount  of  waste  in  a 
year  would  read  somewhat  as  follows: 

Protein  Tons  Billion  Calories 

Consumption 1,660,000  53,900 

Need 1,130,000  40,240 

Waste 530,000  13,660 

According  to  the  Eltzbacher  Commission,  the  waste  of  the  German 
people  was:  protein,  050,000  tons,  and  calories,  31,899,000,000,000. 
The  per  capita  waste  was  thus  greater  in  protein  in  Great  Britain,  greater 
in  calories  in  Germany. 

From  all  available  data,  one  might  adjudge  seven  hundred  thousand 
tons  as  a  reasonable  figure  for  domestic  production  of  protein  in  Great 
Britain.  This  leaves  a  deficit  of  nearly  500,000  tons.  In  other  words, 
the  domestic  production  of  protein  was  about  55  per  cent  of  the  require- 
ments. According  to  Taylor'a  estimate,  the  following  figures  show  ap- 
proximately the  situation  in  Great  Britain  in  the  early  part  of  1917  as 
regards  protein  and  calories: 

Protein  Tons  Billion  Calories 

Consumption 1,660,000  53,900 

Requirements 1,130,000  40,240 

Domestic  production. . .        700,000  19,000 

Deficit 430,000  21,240 


FOOD   SITUATIONS    IN    COUNTRIES    AT    WAR       751 


In  Taylor's  papers  on  the  food  situation  in  Germany,  which  have 
been  largely  employed  as  a  basis  for  this  chapter,  the  lack  of  sugar  was 
referred  to  and  attention  was  drawn  to  the  fact  that  saccharin  was  used 
as  a  substitute.  In  a  report  which  the  same  author  wrote  for  the  Amer- 
ican Embassy  at  Berlin,  he  gave  a  detailed  analysis  of  the  food  of  the 
civil  prisoners  at  Ruhleben  Camp.  But  before  giving  a  part  of  this 
report  and  the  references  therein  to  saccharin,  a  few  comments  will  be 
made  on  the  feeding  of  military  prisoners.  The  ration  established  for 
military  prisoners  in  Germany  in  the  month  of  June,  1916,  contained 
2,700  calories  a  day,  made  up  of  80  grams  of  protein,  29  of  fat,  and  500 
of  carbohydrate.  This,  though  not  plentiful,  was  adequate  as  regards  its 
caloric  value  for  average  men  not  doing  much  muscular  work.  The  pro- 
portion of  fat  is  low,  but  such  a  diet  need  not  endanger  nutrition  in  adults, 
provided  the  requisite  food  value  is  made  up  by  other  foodstuffs.  The 
diet,  however,  for  certain  prisoners  at  Ruhleben  Camp,  and  concerning 
which  Taylor  wrote,  was  indeed  sparse — in  fact,  a  starvation  diet.  In 
the  following  table  the  Ruhleben  diets  are  compared  with  ordinary  stand- 
ards of  living: 

RUHLEBEN  DIETS  COMPARED  WITH  STANDARD  DIETARIES 


Calories 


Protein 


Fat 


Carbo- 
hydrate 


English  laborer 

German  farm  laborer  (Ranke) 

Standard  diet  for  a  man  of  moderate 

activity 

Military  prisoners  of  war  in  Germany. 

Ruhleben  diet  before  reduction 

Diet  actually  taken  when  increased  by 

food  left  by  other  prisoners 

Ruhleben  diet  since  reduction 

Reduced  diet  when  increased  by  food 

left  by  others 


3,655 
4,696 

2,820 
2,700 
1,580 

2,725 
1,220 

1,930 


184 
143 

100 
80 
59 

98 
39 

55 


71 
108 

100 
29 
12 

24 
6 

10 


570 

788 

360 
500 
308 

523 
255 

410 


The  substitution  of  saccharin  for  sugar  in  the  diet  of  the  Ruhleben 
prisoners  was  commented  upon  in  the  Journal  of  the  American  Medical 
Association,  Aug.  12,  1916,  as  a  war  food  abuse.  When  sugar  became 
scarce  in  Germany,  the  law  prohibiting  the  use  of  saccharin  was  abro- 
gated. Two  months  later  its  use  was  made  compulsory  in  certain  direc- 
tions. However,  as  Taylor  points  out,  saccharin  can  never  be  termed  a 
substitute  for  sugar  from  the  gustatory  or  any  other  point  of  view.  Cer- 
tain articles  of  food  containing  saccharin  have  the  normal  taste;  to  other 


752  FOOD    ECONOMICS    IN    WAR 

articles  of  food,  however,  an  abnormal  after-taste  is  given,  a  condition 
particularly  noticeable  in  beer. 

Before  food  regulation  was  introduced  into  Great  Britain,  the  diet 
of  the  munition  workers  had  been  regulated  with  surprisingly  good  re- 
sults. It  must  be  borne  in  mind  that  an  immense  army  of  such  workers, 
a  large  proportion  of  whom  were  women  and  children  of  over  twelve 
years  of  age,  had  been  organized.  It  was  incumbent  on  the  state  from 
every  point  of  view  that  their  health  should  be  carefully  safeguarded,  and 
naturally  a  sufficiently  nutritious  diet  was  a  sine  qua  non  in  the  achieve- 
ment of  this  object.  The  soldier  and  the  sailor  expected  that  their  diet 
would  be  arranged  to  meet  their  particular  needs,  and  when  the  great  rise 
in  the  price  of  food  occurred,  it  was  found  that,  in  order  to  supply  the 
munition  workers  with  food  of  a  character  calculated  to  enable  them  to 
fulfill  their  important  duties  with  efficiency,  they  must  be  dieted  accord- 
ing to  their  special  requirements. 

Dr.  Leonard  Hill  was  chosen  to  make  an  investigation  into  the  mat- 
ter, so  that  he  might  supply  data  upon  which  improvements  in  diet  might 
be  based.  He  laid  down  the  principle  that  the  amount  of  food  taken 
should  be  regulated  solely  by  the  loss  of  energy  it  was  required  to  replace, 
and  pointed  out  that  fortunately  the  chief  foodstuffs  really  provided  all 
the  nourishment  that  was  requisite  for  and  consistent  with  health,  better 
probably  than  the  more  highly  flavored  and  expensive  foods  which  artifi- 
cially stimulate  the  appetite.  Of  such  foods,  Dr.  Hill  gave  the  following 
list :  bread,  margarin,  porridge,  milk,  herrings,  cheese,  beans,  cabbages, 
oranges,  and  the  cheaper  kinds  of  meats. 

Under  his  direction  the  canteen  meals  for  munition  workers  who  came 
from  some  distance  were  analyzed  after  the  following  method:  The  in- 
gredients were  all  thoroughly  mixed,  after  weighing  each  separately,  so 
that  dietaries  could  afterwards  be  constructed  from  the  weights.  An  ali- 
quot part  of  the  intimate  mixture  was  thoroughly  dried  and  weighed.  In 
the  dry  material  protein  was  determined  from  a  nitrogen  estimation,  the 
fat  by  ether  extractions  in  a  Soxhlet's  apparatus,  the  ash  by  burning  and 
weighing,  and  the  carbohydrate  by  difference.  In  this  way  the  amounts 
of  dry  protein,  fat  and  carbohydrate  respectively  in  the  meal  were  ob- 
tained, and  from  these  the  caloric  value  was  determined.  An  analysis 
of  twelve  canteen  meals  showed  that  they  afforded  on  an  average,  protein, 
42.43;  fat,  36.7;  carbohydrate,  146.9  grams,  yielding  1,114  calories  per 
capita.  The  average  canteen  dinner  was  found  to  be  good,  containing  an 
energy  value  of  1,114  calories  well  distributed  among  the  amounts  of 
protein,  fat  and  carbohydrate. 


FOOD    SITUATIONS    IN    COUNTRIES    AT    WAR       753 

The  meals  brought  from  home  by  the  workers  were  also  submitted  to 
analysis.  The  workers  whose  meals  were  thus  obtained  were  not  asked 
beforehand  to  bring  a  sample  meal,  but  were  interrogated  at  the  entrance 
gates  and  asked  to  exchange  the  contents  of  their  basket  for  a  sum  ample 
to  buy  a  meal  at  the  canteen.  In  the  case  of  men,  these  meals  were  found 
to  be  adequate,  but  in  the  case  of  girls  there  was  a  very  wide  variation, 
from  300  up  to  1,100  calories.  As  for  the  latter,  the  breakfast  meal  be- 
fore starting  work  was  often  found  to  consist  of  white  bread  and  boiled 
tea.  Although  there  was  nothing  in  the  investigation  which  was  very 
new,  it  showed  that  a  valuable  degree  of  practical  certainty  was  being 
reached  in  regard  to  the  minimum  adequate  diet  required  for  a  certain 
type  of  manual  labor. 

The  following  table(3)  may  be  of  interest  as  showing  the  diet  during 
the  war,  but  before  voluntary  restriction,  of  three  middle  class  families 
in  England.  The  families  consisted  of  16  persons,  3  men  (sedentary), 
9  women  and  4  children: 

DIETARIES  FOR  THREE  MIDDLE-CLASS  FAMILIES,  SIXTEEN  PERSONS, 
IN  ENGLAND  BEFORE  VOLUNTARY  RESTRICTION 


Weekly 
Weight 

in 
Ounces 

Daily  Yield  in 

Grams 

Energy 

Protein 

Fat 

Carbo- 
hydrate 

Value 

in 

Calories 

Meat,  sausages,  bacon 

50.5 

58.0 

8.9 

28.8 
18.7 

52.4 

2.8 

1.1 

123.1 

36.3 

663 

Bread 

580 

Suear 

145 

Total 

117.4 

47.5 

55.2 

159.5 

1,388 

Cheese 

4.0 
13.2 
32.0 

7.0 
11.6 

3.8 

4.5 
0.5 
2.27 
16.2 
1.6 
3.7 

4.9 
43.3 
0.13 
2.3 
0.7 
0.2 

0.4 

27.2 
21.3 
24.3 

8.7 

63.4 

Butter,  etc 

424.0 

Potatoes 

122.0 

Flour  and  Oatmeal 

103.0 

Rice,  lentils,  etc 

270.0 

Jam  and  dried  fruits   

37.8 

Total 

71.6 

28.77 

53.53 

81.9 

1,020.2 

Total  ration  of  restricted  articles 

47.5 

28.77 

55.53 
53.53 

159.5 
•81.9 

1,388 

Total  of  extras 

1,020.2 

76.27 

108.73 

241.4 

2,408.2 

754  FOOD    ECONOMICS    IN    WAR 

So  far  as  this  examination  went,  it  appeared  to  show  that  the  mem- 
bers of  middle-class  families  in  England  during  the  war,  when  left  to 
their  own  devices,  received  rather  less  protein,  somewhat  more  fat,  and 
considerably  less  carbohydrates  than  the  standard  per  head  of  the  whole 
population,  and  that  the  yield  in  calories  was  about  15  per  cent  less, 
waste  not  being  reckoned. 

From  the  above  table,  the  average  weekly  consumption  of  milk  was 
omitted.  This  reached  the  amount  for  the  three  families  of  4.8  pints 
per  week,  or  0.7  pints  a  head,  bringing  up  the  energy  value  of  the  diet 
per  capita  per  day  to  2,910. 

Voluntary  Rationing  Scheme  in  Great  Britain — A  voluntary  rationing 
scheme  had  been  initiated  in  Great  Britain,  and  was  favorably  commented 
upon  in  an  editorial  which  appeared  in  the  Lancet,  November  17,  1917. 
It  was  pointed  out  that  while  a  faithful  adherence  to  the  limited  amounts 
of  the  staple  foods  outlined  in  the  scheme  would  save  a  grave  situation, 
no  hard  dietetic  or  physiological  sacrifice  was  called  for.  The  staple  foods 
named  were  bread,  flour  and  other  cereals,  meal,  butter,  margarin,  lard 
and  sugar.  Outside  this  list  no  rationing  was  suggested.  Potatoes  were 
not  included  and  therefore,  as  a  valuable  carbohydrate  supply,  might  be 
largely  employed  to  eke  out  the  stock  of  scheduled  foodstuffs,  and  so  save 
the  staples.  In  addition  an  exchange  could  be  made  in  certain  cases, 
notably  Avith  regard  to  bread  and  meat.  Thus  any  person  might  take  half 
a  pound  of  meat  over  and  above  his  meat  ration  in  exchange  for  half  a 
pound  of  bread  to  be  deducted  from  his  bread  ration  and  vice  versa.  The 
Lancet  thought  that  the  scheme  bears  evidence  of  being  well  thought  out 
from  the  economic  point  of  view,  while  it  provided  a  physiological  suffi- 
ciency for  all.  The  public  of  the  United  States  would  do  well  to  bear  this 
in  mind,  for  it  is  important  to  remember  that  a  voluntary  rationing 
scheme  which  provides  amply  for  all  physiological  needs  is  much  less  a 
hardship  than  actual  famine,  while  its  adoption  means  the  releasing  of 
so  much  tonnage,  and  adding  to  the  efficiency  of  transport  service.  In 
plain  words,  the  individual  who  loyally  enters  into  the  spirit  of  the  scheme 
will  be  helping  to  win  the  war,  and  is  doing  so  in  contradiction  to  no  law 
of  physiology  or  of  medicine. 

The  English  scheme  applies  with  force  to  the  food  situation  in  Amer- 
ica. The  people  must  cooperate  in  thrift  so  far  as  food  is  concerned  and 
especially  with  respect  to  the  staple  foods.  However,  the  food  situation 
in  the  United  States  will  be  dealt  with  at  some  length  further  on. 

The  following  table  gives  at  a  glance  the  new  rations  proposed  in 
G-reat  Britain  in  November,  1917: 


FOOD    SITUATIONS    IN    COUNTRIES    AT    WAR       755 
ADULT  RATIONS  IN  GREAT  BRITAIN,  PER  HEAD  PER  WEEK 


Occupations 

Bread 

Other 

Cereals, 

Oz. 

Butter,  Fats, 

Margarine, 

Lard,  Oil, 

Oz. 

Meat, 
lb. 

Sugar, 
oz. 

1.  Men  on  very  heavy  industrial 

or  on  agricultural  work 

2.  Men  on  ordinary  industrial  or 

other  manual  work 

Slb.Ooz. 
7  "  0  " 

4  "  0  " 

5  "  0  " 
4  "  0  " 
3  "  0  " 

12 

10 

2.0 

3.  Men  unoccupied  or  on  seden- 

tary work 

4.  Women  on  heavy    industrial 

work  or  on  agricultural  work 

5.  Women  on  ordinary  industrial 

work  or  in  domestic  work . . 

6.  Women  unoccupied  or  on  sed- 

entary work 

8 

The  bread  rations  included  all  flour,  whether  used  for  bread  or  for 
cooking.  Flour  might  be  taken  instead  of  bread  at  the  rate  of  %  lb.  of 
flour  for  every  pound  of  bread. 

The  other  cereal  rations  included  oatmeal,  rice,  tapioca,  sago,  barley 
meal,  corn  flour,  maize  meal,  dried  peas,  beans  and  lentils,  and  all  cereal 
products  except  bread  and  flour.  The  weight  given  was  the  weight  of 
the  dry  article,  as  bought.  If  the  full  bread  ration  was  not  used,  the 
amount  saved  could  be  taken  in  other  cereals.  The  "meat"  rations  in- 
cluded the  average  amount  of  bone,  which  might  be  taken  as  one  quarter 
of  the  weight  of  the  actual  meat.  Any  parts  of  meat,  snch  as  rump  steak, 
bacon  or  suet,  which  were  bought  without  bone,  must  count  for  one- 
quarter  more  than  their  actual  weight.  On  the  other  hand,  any  bone 
in  excess  of  a  quarter  of  the  actual  meat  bought  might  be  deducted. 
Poultry  and  rabbits  might  be  counted  at  half  their  actual  weight.  The 
meat  rations  included  suet. 

Sir  Arthur  Yapp,  who  outlined  the  scheme,  divided  the  population 
into  six  sections,  three  for  men  and  three  for  women.  Children  were  to 
receive  their  reasonable  ration  of  essential  foods,  and  as  their  needs  differ 
so  widely,  a  definite  ration  was  omitted  for  them.  Broadly,  the  scheme 
provided  more  bread  but  less  meat  and  sugar. 

A  very  pertinent  table  on  the  unrestricted  diet  of  a  sedentary  worker 
was  published  by  Dr,  A,  D.  Waller,  r.R.S.(4),  a  well-known  physiologist 
and  the  author  of  a  standard  text-book  on  physiology.  The  following  table 
gives  the  constituent  parts  of  I)r,  Waller's  meals  on  three  successive  days, 
and  it  will  be  gathered  from  this  table  that  his  average  caloric  consump- 


756 


FOOD   ECONOMICS   IN   WAR 


tion  for  the  three  days  was  2,471,  inclusive  of  227  calories  of  claret  and 
whiskey,  of  which  the  caloric  value  is  not  undisputed.  Of  the  total  2,471, 
breadstuffs  constituted  840  calories,  which  is  equivalent  to  r334  grams  of 
breadstuffs;  of  the  334  grams  of  breadstuffs,  200  grams  were  loaf  bread 
and  134  grams  were  puddings,  etc. ;  100  parts  of  his  bread  material,  there- 
fore, were  made  up  of  60  parts  of  loaf  bread  and  40  parts  of  other  farina- 
ceous materials. 


THE   UNRESTRICTED   DIET  OF   A   SEDENTARY   WORKER 

October  3bd,  1916 

1.     Early  Tea 


c/o  assumed 

Grains 

Protein 

Fat 

Carbo- 
hydrate 

Calories 

Protein 

Fat 

Carbo- 
hydrate 

8 

1 

80 

4 

50 

"5 
100 

Bread 

20 

5 

20 

10 

1.6 

0.05 

0.7 

0.2 
4.0 
0.8 

10.0 

1.6  ■ 

10.0 

49.42 
37.405 
14.41 
41.0 

1 

Butter 

3.5 

Milk 

2.35 

5.0 

11.0 

142.235 

8 

1 

1 

80 

3.5 

4 

10 

50 

12 

12 

0.5 


Breakfast 


0.1 


50 
"5 


100 
50 


Bread 

Butter 

Milk 

Bacon 

Egg 

Sugar 

Marmalade. 


75 

6.0 

0.75 

37.5 

185.325 

30 

0.3 

24.0 

224.43 

300 

10.5 

12.0 

15.0 

216.15 

20 

2.0 

10.0 

101.20 

50 

6.0 

6.0 

25 

25.0 

102.50 

50 

0.25 

0.5 

25.0 

103.99 

25.05 

52.8 

102  5 

1,013.995 

3.    Lunch 


8 

1 
15 
25 

5%  Ale. 


1 
80 

5 
25 


50 


2.5 
100 


Bread. . 
Butter. . 
Meat. . . 
Cheese. 
Sugar. . 
Wine. . . 


60 

4.8 

0.6 

30.0 

148.26 

15 

0.15 

12.0 

112.215 

25 

3.75 

1.25 

27.0 

15 

3.75 

3.75 

0.375 

51.7875 

10 

10.0 

41.0 

(150) 

12.45 

17.6 

40.375 

380.262 

(52.5  cals.) 


Afternoon  Tea 

Nil. 
5.     Dinner 


2 

2 

6 

10 

2 

15 

5 

8 

1 

50 

2 

2 

40 

2 

0.1 

20 

1 

80 

25 

25 

2.5 

10 

1.0 

85 

5%  Ale. 

100 

Soup .... 

Fish 

Meat. . . . 
Bread . . . 
Pudding. 
Potatoes. 
Butter... 
Cheese. . 
Biscuits. . 
Wine.... 
Sugar . . . 


150 

3.0 

3.0 

9.0 

77.1 

40 

4.0 

0.8 

23.84 

60 

9.0 

3.0 

64.8 

30 

2.4 

0.3 

15.0 

74.13 

50 

1.0 

1.0 

20.0 

95.4 

50 

1.0 

0.05 

10.0 

45.565 

5 

0.05 

4.0 

37.405 

10 

2.5 

2.5 

0.25 

34.525 

25 

2.5 

0.25 

21.25 

99.7 

(300) 

15 

15.0 

61.5 

25.45 

14.9 

90.5 

613.966 

(105  cals.) 


6.     Supper 


50%  Ale. 
10  1 


85 


Whiskey. 
Biscuits. . 


Total 

Total  calories 


(30) 
25 

2!5' 

6.25 

21.25 

'  '99,7 

2.5 

0.25 

21.25 

99.7 

67.8 

99.55 

280.625 

2,270.657 

2,533.157 

(105  cals.) 


-I-Total  (262.5) 


FOOD    SITUATIONS    IN    COUNTRIES    AT    WAR       757 

THE    UNRESTRICTED    DIET    OF    A   SEDENTARY    WORKER— Continued 

OcTOBEE  4th,   19 1G 
1.     Early  Tea 


c/o  assumed 

Grams 

Protein 

Fat 

Carbo- 
hydrate 

Calories 

Protein 

Fat 

Carbo- 
hydrate 

8 

1 

80 

4 

50 

"5 
100 

Bread 

20 

5 

20 

10 

1.6 

0.05 

0.7 

0.2 
4.0 
0.8 

10.0 

'  1.6 
10.0 

49.42 
37.405 
14.41 
41.0 

1 

Butter 

3.5 

Milk 

2.35 

5.0 

21.0 

142.235 

2.     Breakfast 


15 

8 

1 

3.5 
10 
12 

0.5 


8 

1 
80 

4 
50 
12 

0.1 


60 
50 


50 
100 


Porridge  (20  dry) . 

Bread 

Butter 

Milk 

Bacon 

Egg 

Marmalade 

Sugar 


100 

3.0 

1.6 

12.0 

76.38 

60 

4.8 

0.6 

30.0 

148.26 

30 

0.3 

24.0 

224.43 

400 

14.0 

16.0 

20.0 

288.20 

20 

2.0 

10.0 

101.20 

50 

6.0 

6.0 

80.40 

50 

0.25 

0.05 

25.0 

103.99 

25 

25.0 

102.0 

30.35 

58.25 

112.0 

1.125.36 

3.     Lunch 


8 

1 

80 

2 

2 

50 
40 

Bread 

45 
10 
60 
60 

(150) 

3.6 
0.1 
6.0 
1.2 

0.45 
8.0 
1.2 
1.2 

22.5 
24.5' 

111.195 
74.81 
35.76 

114.48 

1 

Butter 

10 

Fbh 

2 

6%  Ale. 

Wine 

(52.5  cals.) 

10.9 

10.85 

46.5 

336.245 

Afternoon  Tea 


1 
'3.5 


1 

50 

80 

100 

4 

5 

Bread. 
Butter, 
Sugar . 
Milk.. 


40 

3.2 

0.4 

20.0 

98.84 

10 

0.1 

8.0 

74.81 

5 

5.0 

20.50 

10 

0.35 

0.4 

0.5 

7.205 

3.65 

8.8 

25.5 

201.355 

5.     Dinner 


15 

8 

2 

2 

1 
25 
10 

6%'aIc. 


5 

1 

2 

0.1 
80 
25 

1 


50 
40 
20 

'  '2.5 
85 
100 


Meat. . . . 
Bread . .  . 
Pudding. 
Potatoes. 
Butter. . . 
Cheese.  . 
Biscuits. . 
Sugar. . . 
Wine 


40 

6.0 

2.0 

43.2 

45 

3.6 

0.45 

22.5 

111.195 

80 

1.6 

1.6 

32 

152.640 

80 

1.6 

0.08 

16 

72.904 

5 

0.05 

4.0 

37.405 

10 

2.5 

2.5 

0.25 

34.525 

12.5 

1.25 

0.125 

10.625 

49.850 

5 

5.0 

20.500 

(100) 

16.6 

10.755 

86.375 

522.219 

(35  cab.) 


148 


6.     Supper 


s 

1 
25 

50 
2.5 

Bread 

15 
20 

(30) 

1.2 
5.0 

0.15 
5.0 

7.5 
0.5 

37.065 
69.050 

25 

Cheese 

60%  Ale 

Whiskey 

(105  cals.) 

Total  calories  = 

6.2 

5.15 

8.0 

106.115 

70.05 

98.805 

299.375 

2,433.529 

-1- (192.6) 

2.626.029 

758 


FOOD    ECONOMICS    IN    WAR 


-Continued 


THE    UNRESTRICTED    DIET    OF   A   SEDENTARY    WORKER- 

OcTOBEB  5th,   1916 
1.    Eablt  Tea 


c/o  assumed 


Protein      Fat     Carba- 


Grams 


Protein 


Fat 


Carbo- 
hydrate 


Calories 


1 
3.5 


1 

80 
4 


50 


5 
100 


Bread., 
Butter. 
Milk. . . 
Sugar . . 


30 
5 

30 
5 


2.4 

0.05 

1.05 


0.3 
4.0 
1.2 


15.0 


1.5 
5.0 


5.5 


21.5 


74.13 
37.405 
21.615 
20.5 


153.65 


2.     Breakfast 


15 

8 

1 

3.5 
10 

0.5 


8 

60 

1 

50 

80 

4 

5 

2 

100 

0.1 

50 

Porridge  (20  dry) . 

Bread 

Butter 

MUk 

Fish 

Sugar 

Marmalade 


100 

3.0 

1.6 

60 

4.8 

0.6 

15 

0.15 

12.0 

400 

14.0 

16.0 

65 

6.5 

1.3 

10 

50 

0.25 

0.5 

28.7 

31.55 

12.0 
30.0 


20.0 


10.0 
25.0 


76.38 
148.26 
112.215 
288.2 

38.74 

41.0 
103.99 


808.785 


Lunch 


8 

1 

50 

15 

5 

2 

0.1 

20 

1 

80 

5%  Ale. 

2 
15 

8 
2 
2 
25 
1 

0.5 
5%  Ale. 


Bread . . . 

Meat 

Potatoes. 
Butter. . . 
Wine 


2 

6 

5 

1 

50 

0.1 

20 

2 

40 

25 

2.5 

80 

0.1 

50 

»oup .... 
Meat. . . . 
Bread . . . 
Potatoes. 
Pudding . 
Cheese.  . 
Butter. . . 

Jam , 

Wine 


40 

3.2 

0.4 

30 

4.5 

1.5 

30 

0.6 

0.03 

5 

0.05 

4.0 

(150) 

8.35 

5.93 

20.0 
6.0 


26.0 


98.84 
32.4 
27.339 
37.405 


195.984 


200 

4.0 

4.0 

85 

12.75 

4.25 

60 

4.8 

0.6 

60 

1.2 

0.06 

80 

1.6 

1.6 

15 

3.75 

3.75 

10 

0.1 

8.0 

20 

0.1 

0.02 

(200) 

28.3 

22.28 

12.0 

30.6' ' 
12.0 
32.0 
0.375 

10.0  ' 


96.375 


102.8 

91.8 
148.26 

54.678 
152.64 

51.7875 

74.81 

41.596 


(52.5  cals. 


4 

Afternoon  Tea 

3.5 

4 

5 
100 

Milk 

15 
5 

0.525         0.6 

0.75 
5.0 

10.8075 
20.5 

Sugar 

0.525     1     0.6 

5.75 

•     31.3075 

5.       DiNNEB 

718.3715 


(70  cals.) 


6. 

Sdppeb 

50%Alc 

1 

85 

Whiskey 

(30) 
30 

3.6' 

613 

25.5  ■ 

'119.64 

(105  cals.) 

10 

Total 

Total  calories  = 

72.375 

66.16 

272.125 

2,027.738 

-|-(227.5:cal8.) 

2,255.238 

Summary 


Protein 

Fat 

Carbohy- 
drates 

Calories 

Calories 
(Ale.) 

October  3rd 

67.8 

70.05 

72.375 

90.55 

98.805 

66.16 

280.625 
299.375 
272.125 

2,270.657 
2,433.529 
2,027.738 

262.5 

October  4th 

192.5 

October  5th 

227.5 

Total  for  3  days 

210.225 
70.075 

255.515 
85.1717 

852.125 
284.0417 

6,731.924 
2,243.975 

682.5 

227.5 

2,471.475 

UiSE    OF    CERTAIN    FOODSTUFFS    IN    WAR  759 

Of  course,  Dr.  Waller's  case  was  uot  representative.  He  was  60  years 
of  age,  weighed  190  pounds,  and  belonged  to  the  class  of  sedentary 
workers  whose  caloric  requirements  are  considerably  lower  than  those  of 
the  manual  worker.  Still  it  is  a  matter  for  some  surprise  that  his  calories 
should  be  as  low  as  2,244.  It  is  interesting  to  note  that  Waller  in  his 
"Text-book  of  Physiology"  has  given  3,000  as  the  average  calorie  re- 
quirement per  working  man  per  day  for  food  as  eaten,  and  that  this  should 
have  as  its  foundation  1  pound  of  bread  per  day. 

USE  OF  CERTAIN  FOODSTUFFS  IN  WAR 

Bread  and  Cereal  Foods. — With  regard  to  the  value  of  bread  as  a  staple 
diet,  it  is  instructive  to  note  that  the  ordinary  prison  diet  in  an  English 
jail,  adopted  in  1889,  contains  3,040  calories,  of  which  the  bread,  inclusive 
of  flour  and  oatmeal,  amounts  to  2,378  calories,  of  which  1,715  calories 
are  afforded  by  22  ounces  per  day  of  actual  bread.  On  this  diet  it  was 
found  that  82  per  cent  of  the  prisoners  gained  weight,  while  18  per  cent 
lost  weight.  This  brings  us  to  the  question  of  bread  and  its  value  as  a 
food. 

One  of  the  most  valuable,  perhaps  the  most  valuable,  lesson  that  the 
war  has  taught  us,  or  rather  has  emphasized,  is  that  highly  milled  bread 
is  less  nutritious  than  whole-meal  bread.  It  is  now  known  that  the  con- 
sumption of  cereals  from  which  the  husks  have  been  removed,  when  used 
as  a  sole  or  main  means  of  nutriment,  is  responsible  for  disease.^  Beri- 
beri, pellagra,  scurvy  and  probably  rickets  have  all  been  traced  more  or 
less  to  this  cause.  Bread  made  from  highly  milled  flour  when  constituting 
but  a  part  of  the  diet,  is  not  directly  responsible  for  diseased  conditions, 
but  from  the  outlook  of  health  is  not  to  be  recommended.  It  tends  to  con- 
stipation, because  'it  requires  little  mastication  and  also  requires  little  ex- 
ercise by  the  organs  of  digestion ;  it  is  smooth  and  does  not  irritate  the 
digestive  organs,  or  induce  internal  secretions  to  exertion,  and  conse- 
quently it  is  apt  to  take  an  undue  time  for  assimilation  and  absorption, 
and  for  its  waste  products  to  pass  through  the  intestinal  tract.  Moreover, 
according  to  the  most  recent  views,  the  very  part  of  the  cereal  that  is 
milled  or  taken  away  is  that  which  contains  food  elements  which  are 
indispensable  for  growth  and  the  maintenance  of  life.  These  have  been 
termed  "accessory  diet  factors"  or  "vitamines."  They  may  be  conceived 
of  as  stimulating  certain  physiological  processes  and  as  essential  to  cer- 
tain functions. 


1  See  also  Volume  II,  Chapter  VIII;  Volume  III,  Chapter  XVII. 


760  FOOD    ECONOMICS    IN    WAR 

As  Mendel(5)  has  pointed  out,  the  lubricant  is  quite  as  important  to 
a  machine  as  the  energj-furnishing  fuel.  In  a  similar  way  these  diet  ac- 
cessories or  "vitamines"  may  possess  peculiar  usefulness.  Some  of  them 
are  believed  to  be  easily  impaired  by  heat ;  in  the  language  of  the  chem- 
ist, they  may  be  thermolabile.  Hence  the  use  of  heat  for  preserving  or 
sterilizing  foods  suggests  new  difficulties.  They  may  be  lost  in  the  wastes 
of  the  modern  technical  processes,  as  in  the  milling  of  cereals.  Wheat, 
for  example,  by  modern  milling  is  denuded  of  its  pericarp.  A  beauti- 
fully smooth  white  flour  results  which  has  been  deprived  of  a  considerable 
amount  of  its  nutritive  virtues  and  is  hardly  suitable  as  food  for  a  human 
being,  supplied  with  a  strong  jaw  and  teeth  intended  to  be  employed  in 
mastication. 

The  food  orders  in  Great  Britain,  promulgated  chiefly  with  the  view 
of  economizing  food,  although,  of  course,  distasteful  to  the  mass  of  the 
population,  have  proved  with  regard  to  the  preparation  of  bread,  a  bless- 
ing in  disguise.  Bread  in  all  countries,  and  in  Great  Britain  in  particu- 
lar, is  the  chief  means  of  sustenance  of  the  working  classes,  and  it  is 
somewhat  curious  that  the  necessities  of  war  should  have  brought  into 
force  a  measure  which,  regarded  from  the  public  health  standpoint,  is  as 
important  as  any  measures  which  have  been  brought  forward  in  modern 
times.  Wheat,  of  all  the  cereals  used  for  the  manufacture  of  bread,  is, 
perhaps,  the  most  nutritious.  At  any  rate,  it  has  the  most  delicate  flavor, 
it  contains  a  large  amount  of  gluten,  and  for  making  bread  is,  on  the 
whole,  the  most  popular  product  of  the  earth.  In  addition,  wheaten 
flour,  unlike  the  flour  of  other  cereals,  is  readily  kneadable,  and  can 
therefore  be  made  into  bread,  macaroni,  vermicelli,  pastry,  and  all  kinds 
of  puddings  and  cakes. 

The  first  food  orders  issued  in  England  called  for  the  extraction  of 
76  per  cent  from  the  total  grain;  a  few  weeks  later  the  extraction  of  a 
further  5  per  cent  was  ordered ;  and  it  may  be  said  that,  after  the  early 
summer  of  1917,  the  wheaten  bread  consumed  in  Great  Britain  was  to 
all  intents  and  purposes  whole-grain  bread.  An  option,  however,  was 
given  to  millers  to  mix  with  the  wheat,  flour  derived  from  barley,  maize, 
rice  or  oats,  to  the  extent  of  10  per  cent.  This  meant  that  the  miller  need 
not  mill  his  wheat  further  than  the  original  allowance  of  76  per  cent, 
provided  he  added  a  proportion  of  other  flours.  It  is  possible  to  add  to 
flours  rich  in  gluten  a  proportion  of  starch,  as  for  example,  flour  made 
from  corn,  without  materially  reducing  the  nitrogen  value  when  compared 
with  a  low-grade  wheaten  flour.  The  energy  value  of  a  loaf  from  such 
flour  would  be  quite  high,  while  its  nourishing  properties  would  be  little 


USE  OF  CERTAIN  FOODSTUFFS  IN  WAR     761 

impaired.  Corn  flour  and  rice,  however,  would  somewhat  detract  from 
its  protein  value,  while  barley  and  oats  would  add  proteins  and  fat.  The 
loaf  containing  an  addition  of  barley  and  oats  would,  from  a  dietetic  point 
of  view,  likely  enough,  have  a  superior  value  to  the  loaf  made  with  a 
similar  proportion  of  corn  or  rice. 

To  those  who  hold  that  bread  is  primarily  eaten  not  so  much  as  a 
source  of  protein,  but  as  an  easily  digestible,  attractive  form  of  starch,  it 
matters  little  which  flour  is  employed.  Obviously^  however,  in  war  time, 
the  question  of  cost  is  predominant  and  the  wheat  substitutes  can  be  used 
for  no  good  purpose  unless  they  are  cheaper  than  wheat  flour  itself.  It 
may  be  pointed  out  that  in  America,  from  this  standpoint,  com  particu- 
larly commends  itself  as  a  food.  Apart  from  this  point,  the  physical 
qualities  of  a  loaf  of  bread  must  be  considered,  texture  for  one  thing  being 
an  important  property.  The  characteristics  which  formerly  chiefly  com- 
mended a  loaf  of  wheaten  bread  were  that  it  was  light  and  spongy,  easily 
masticated  and  digestible.  It  goes  without  saying  that  the  lumpy,  sodden 
loaf  is  unattractive  and  indigestible,  and  its  food  value  may  be  largely 
discounted  owing  to  its  causing  gastric  trouj^les.  On  the  other  hand, 
while  a  loaf  should  be  light,  it  is  an  advantage  that  it  should  be  so  baked 
that  externally  it  is  hard  and  crusty,  affording  plenty  of  work  for  the 
jaws,  teeth  and  salivary  glands. 

Nearly  all  the  vegetable  foods  which  invite  mastication  are  crusty 
bread,  dry  toast,  hard  biscuits,  salads,  nuts  and  apples.  Our  staple  vege- 
table food — wheaten  bread — is  almost  invariably  eaten  in  a  spongj'  form. 
The  loaves  are  shaped  so  as  to  afford  a  minimum  of  surface  for  crust,  and 
are  lightly  baked  so  that  the  crust  shall  be  as  thin  as  possible.  In  fact, 
the  prejudice  that  the  majority  of  people  have  against  crust  is  such  that 
the  most  crusty  loaves,  those  which  have  rested  on  the  floor  and  against 
the  sides  of  the  oven,  fetch  a  lower  price  than  the  others. 

The  more  thoroughly  a  farinaceous  food,  as  bread,  is  chewed,  the 
more  intimately  will  it  be  mixed  with  the  saliva,  and  the  more  efficiently 
is  it  likely  to  be  digested.  It  is  certain,  furthermore,  that  when  food  is 
well  digested,  it  will  go  further,  and  less  of  it  will  be  required  than  when 
it  is  not  well  digested.  Thus,  a  piece  of  crusty  bread  well  masticated 
will  go  a  longer  way  to  satisfy  the  appetite  and  the  nutritive  requirements 
of  the  system  than  an  equivalent  of  pudding  or  of  some  of  the  soft  mushy 
food  which  has  such  a  vogue  in  this  country.  TMiile  by  no  means  a  dis- 
ciple of  Fletcher,  who  unduly  exalts  the  merits  of  mastication,  and  who 
advocates  its  practice  to  absurd  lengths,  the  author  is  convinced  that  it 
would  bo  in  the  best  interests  of  the  health  of  the  community  at  large  if 


762  FOOD   ECONOMICS    IN    WAR 

more  mastication  were  practiced,  particularly  with  regard  to  the  carbo- 
hydrates— in  short,  if  less  soft  food  were  eaten. 

The  best  way  to  secure  adequate  mastication  is  to  select  foods  which 
invite  or  even  compel  it.  It  is  chiefly  in  regard  to  wheaten  flour,  oatmeal 
and  rice  that  reform  is  most  needed.  Many  people  in  England,  at  the 
time  of  writing,  are  wondering,  now  that  war  bread  has  made  its  appear- 
ance, why  they  ever  preferred  the  bread  made  from  highly  milled  flour. 
The  ideal  loaf  of  wheaten  bread  from  the  nutritive  standpoint  is  the 
crusty  one  made  from  whole-meal,  which  needs  more  mastication  than 
the  spongy  loaf,  promotes  good  digestion,  excites  peristaltic  action,  and, 
above  all,  contains  those  food  elements  known  as  vitamineSj  which  stimu- 
late certain  physiological  processes  and  are  essential  to  the  perfect  well- 
being  of  the  organism  as  a  whole. 

Of  other  cereal  foods  than  wheat,  oats  in  the  form  of  oatmeal,  corn 
and  rice  occupy  the  first  places.  From  the  aspect  of  protein  value,  oat- 
meal is  the  most  nutritious,  containing  as  it  does  more  protein  than  wheat 
and  considerably  more  fat.  Rice  is  less  nutritious  than  wheat  or  oats, 
and  inasmuch  as  it  is  polished  rice  which  is  imported,  and  which,  eaten 
solely,  constitutes  the  deficiency  diet  par  excellence,  its  employment  as  a 
staple  of  diet  is  not  indicated. 

With  regard  to  oatmeal  as  a  war  food,  it  may  be  recommended  both 
on  the  grounds  of  economy  and  nutritive  properties.  It  is  in  itself  a 
valuable  food,  but  in  the  form  of  porridge  does  not  conduce  to  mastica- 
tion. Moreover,  the  oatmeal  flour  sold  nowadays  is  made  from  oats  which 
have  been  denuded  of  their  husks,  and  is,  when  made  into  porridge,  an 
especially  soft  and  pappy  article  of  diet.  The  good,  coarse  Scotch  oat- 
meal porridge  of  yore,  which  required  a  certain  amount  of  mastication, 
and  which  contained  the  husks  of  grain  in  which  were  the  vitamines,  is 
no  longer  seen  in  this  country.  In  its  place  is  offered  a  smooth  bland  sub- 
stance, wholly  devoid  of  the  irritating,  health-giving  elements  referred  to 
and  affording  not  the  slightest  exercise  to  the  jaws,  teeth  or  the  salivary 
glands.  From  the  point  of  view  of  mastication,  oatmeal  biscuits  are  pref- 
erable to  oatmeal  porridge,  but  the  latter  is  so  popular  and  valuable  a 
food  that  it  may  be  permitted  in  war  time  with  the  proviso  that  it  is  made 
from  whole-meal  and  that  it  is  subjected  to  some  sort  of  chewing. 

While  the  good  influence  of  protein  consumption  on  health  may  have 
been  exaggerated,  and  while  the  need  for  a  large  protein  intake  may  have 
been  overestimated,  it  is  still  allowed  on  all  hands  that  a  certain  amount 
of  protein  is  necessary  for  the  maintenance  of  the  bodily  powers  at  a  high 
standard.     Many  even  hold  that  a  considerable  protein  intake  is  benefi- 


USE    OF    CERTAIN    FOODSTUFFS    IN    WAR  763 

cial,  aud  the  author  is  one  of  these.  It  must  be  remembered  that  the  pro- 
tein molecule  is  composed  of  a  group  of  dissimilar  chemical  units,  many 
of  which  appear  to  be  indispensable  for  the  nutritive  functions.  As  the 
animal  body  cannot  construct  all  of  these  synthetically,  it  is  dependent 
for  a  supply  thereof  upon  the  diet.  The  proteins  of  foods  commonly 
eaten  provide  these  essential  units  in  unlike  yields.  Accordingly,  the 
view  is  gaining  ground  that  an  adequate  ration  must  furnish  these  units 
in  amounts  sufficient  quantitatively  and  qualitatively. 

Corn  possesses  satisfactory  nutritive  properties  in  many  directions, 
but  is  somewhat  lacking  in  its  protein  contents,  or  perhaps  it  would  be 
more  correct  to  say  that  corn  and  the  by-products  of  the  corn  kernel  are 
considered  as  a  result  of  laboratory  analysis,  inadequate  for  good  feeding 
purposes  unless  they  are  supplemented  by  other  protein-containing  food. 
It  has  been  suggested  by  scientific  authorities  that  the  addition  of  supple- 
mentary proteins — perhaps  those  which  are  present  in  dried  milk  prod- 
ucts— might  render  such  a  food  as  com,  which  in  this  country  is  plentiful 
and  inexpensive,  but  to  some  extent  possibly  inefficient  from  the  protein 
standpoint,  considerably  more  valuable  as  a  staple  article  of  diet.  By 
many  it  is  argued,  however,  that  the  slight  lack  of  protein  in  corn,  com- 
pared with  wheat  and  oats,  detracts  little  if  any  from  its  nutritive  value. 
Practical  experience  has  demonstrated  that  it  is  a  wholesome  food,  and, 
after  all,  it  is  experience  that  is,  taking  everything  into  consideration,  the 
surest  guide. 

According  to  Dr.  Haven  Emerson,  Health  Commissioner  of  New 
York,  corn  meal  afforded  the  same  amount  of  nourishment  as  wheat  flour 
and  was,  at  any  rate,  in  April,  1917,  25  per  cent  cheaper.  No  doubt, 
from  several  points  of  view  this  statement  is  correct,  and  corn  meal  is  a 
nourishing  form  of  food  and  one  considered  from  the  outlook  of  food 
economies  in  war  time,  to  be  advocated  as  a  staple  diet.  Yet,  as  in  the 
case  of  wheat,  oats  and  rice,  in  fact  of  all  cereals,  corn  deprived  of  its 
husks  is  a  less  nutritive  aliment  by  far  than  w^hen  these  are  allowed  to 
remain.  More  than  a  strong  suspicion  has  been  aroused,  approaching 
indeed  conviction,  by  the  researches  of  Voegtlin  and  others,  that  pellagra 
is  a  deficiency  disease,  and  that  its  prevalence  in  the  Southern  States  is 
largely  if  not  entirely  owing  to  the  manner  in  which  corn,  which  is  the 
staple  diet  of  the  population,  is  milled.  It  is,  then,  as  obvious  in  the 
instance  of  com  as  in  that  of  rice,  wheat,  oats  and  other  cereals,  that  it 
should  not  be  highly  milled  in  order  to  obtain  the  greatest  nutritive 
benefit  from  its  consumption.  The  war  has  taught  and  emphasized  the 
point  that  all  cereals  regarded  from  the  health  and  economical  aspects 


764  FOOD    EC0:N0MICS    IX    WAR 

should  be  so  milled  or  prepared  for  human  consumption  that  the  coarser 
parts  should  be  left  for  reasons  which  have  been  fully  explained  in  differ- 
ent portions  of  this  work. 

A  great  advantage  possessed  by  corn  as  a  food  is  that  it  is  pleasant 
to  the  palate  and  that  it  may  be  cooked  and  prepared  in  a  variety  of  ways, 
while  above  all  it  is  cheap.  Our  readers  may  be  reminded  of  the  fact  that 
during  the  Civil  War  soldiers  subsisted  for  considerable  periods  of  time 
almost  wholly  upon  corn,  employing  it  even  as  a  vehicle  for  making  a 
substitute  for  coffee. 

Potatoes. — It  is  hardly  necessary  to  dwell  upon  the  fact  that  potatoes 
are  factors  of  much  importance  in  war-time  feeding.  A  bountiful  potato 
crop  probably  saved  Germany  at  a  very  critical  period.  Potatoes,  how- 
ever, do  not  provide  such  reliable  crops  as  the  cereals,  and  if  a  potato 
crop  fails,  it  usually  fails  wholly.  It  may  be  pointed  out  that,  as  a  rule, 
there  is  gross  waste  in  the  preparation  of  potatoes  for  food.  There  is  no 
need — indeed,  in  war  time,  the  custom  should  be  strongly  discountenanced 
if  not  prohibited — of  peeling  potatoes  before  cooking  them.  A  useful 
part  of  the  potato  is  removed  with  the  skin,  and  the  majority  of  people 
can  eat  potato  skin  with  advantage.  Special  care  should  be  taken  not  to 
waste  the  highly  nutritious  potato.  Potato  bread  is  a  pleasant  and  sat- 
isfying food,  and  it  is  a  good  plan  to  make  it  of  cooked  potatoes  which 
might  otherwise  be  wasted. 

Milk. — The  question  of  milk  is  a  very  obtrusive  one  in  war  time.  It 
has  become  almost  an  article  of  faith  that  a  large  supply  of  milk  is  indis- 
pensable to  the  maintenance  of  good  health,  and  that,  if  a  milk  supply 
failed  wholly  or  in  part,  the  consequences  would  be  disastrous.  In  time 
of  war,  foodstuffs  and  feeding  materials  must  be  economized.  To  find 
feeding  material  sufficient  to  maintain  cows  in  such  a  condition  that  they 
will  provide  a  good  supply  of  milk,  implies  a  great  deal  of  labor  and  also 
the  importation  of  an  amount  of  feeding  material  which  is  inconvenient 
when  not  impossible  under  war  conditions.  It  is  assuredly  true  that  to 
conserve  infant  life,  a  certain  supply  of  cow's  milk  is  necessary,  that  is, 
in  the  existing  state  of  affairs,  when  so  many  women  do  not  suckle  their 
offspring.  But  that,  after  the  baby  age  is  passed,  milk  is  an  absolutely 
essential  article  of  diet  is  strongly  combated  by  many  authorities.  Camp- 
bell (6)  went  so  far  as  to  declare  that  the  child,  as  distinguished  from  the 
babe,  does  not  need  milk  and  would  not  suffer  greatly  if  the  supply  of 
dairy  milk  suddenly  failed.  He  argued,  in  the  first  place,  that  milk, 
affording  as  it  does  a  peculiarly  favorable  soil  for  the  growth  of  disease 
germs,  has  carried  disease  and  death  to  h.ecatombs  of  children.     It  has 


USE  OF  CEETAIN  FOODSTUFFS  IN  WAR    765 

further  acted  injuriously  by  favoring  the  consumption  of  soft,  pappy 
foods.  It  is  obvious  that  the  infant,  like  the  young  of  other  mammals, 
requires  milk  for  the  first  period  of  its  life,  and  that  the  proper  milk  for 
it  is  that  of  its  own  mother.  When  this  source  of  supply  fails  or  is  not 
available,  as  so  frequently  occurs  in  these  days,  resort  must  be  had  to  the 
milk  of  other  animals,  cows  or  goats.  This  has  not  proved  an  unmixed 
blessing,  but  the  question  has  been  so  thoroughly  covered  in  Volume  II, 
Chapter  XV,  and  Volume  III,  Chapter  XXIV,  that  it  would  be  super- 
fluous to  lay  further  stress  on  this  phase  of  the  matter. 

According  to  Campbell,  while  the  infant  needs  milk  of  some  kind 
during  the  first  nine  or  ten  months  of  life,  it  does  not  need  any  after  that 
period.  Why  should  the  young  of  man  any  more  than  the  young  of  other 
mammals  require  milk  after  it  has  left  the  breast  ?  It  is  only  since  man 
first  domesticated  the  cow  and  goat — and  this  from  the  point  of  view  of 
his  evolution  was  but  as  yesterday — that  he  has  been  supplied  with  any 
milk  other  than  human,  and  it  is  absurd  to  suppose  that  before  that  time 
his  health  suffered  from  the  lack  of  cow's  or  goat's  milk.  The  pre-agri- 
cultural  tribes  to  this  day  are  without  any,  and  until  civilized  man  de- 
teriorated them  by  the  introduction  of  alcohol  and  European  vices,  they 
were  magnificent  physical  specimens  of  manhood. 

The  argument  is  not  made  that  dairy  milk  is  a  useless  food  for  man, 
but  merely  that  it  is  not  essential  to  him  after  the  nursing  period.  Its 
chief  value  to  the  human  race  is  as  a  source  of  butter  and  cheese,  two 
highly  concentrated  and  agreeable  foods,  admitting  of  prolonged  storage, 
as  not  only  cheese  but  salt  butter  may  be  kept  for  many  months.  Un- 
doubtedly cheese  is  a  very  valuable  form  of  food  in  war  time,  on  account 
of  the  large  amount  of  protein  that  it  contains.  The  manufacture  of  milk 
into  butter  and  cheese  rather  than  its  use  in  the  form  of  milk,  especially 
into  cheese,  is  prompted  by  considerations  of  health  and  economy  alike. 

Sugar. — Another  article  of  food  which  has  given  rise  to  violent  and 
persistent  discussion,  and  the  use  of  which  has  been  the  most  vexed  ques- 
tion of  all  with  regard  to  food  economics  in  Great  Britain  and  Germany, 
is  sugar.  In  Germany  sugar  was  consumed  in  immense  quantities, 
mainly,  perhaps,  because  that  country  produced  it  on  the  largest  scale. 
Now  so  short  is  the  supply  there  that,  as  noted  previously,  saccharin  has 
been  substituted.  It  was  not  long  ago  that  sugar  was  lauded  as  an  essen- 
tial, Now  neither  scientific  men  nor  practical  observers  speak  so  de- 
cidedly in  favor  of  sugar  as  a  necessary  ingredient  or  part  of  a  diet. 
^Afendel  says  that,  although  sucrose,  the  form  in  which  it  is  generally  used, 
has  a  considerable  fuel  value  in  the  organism,  its  dietary  use  is  primarily 


766  FOOD    EC0:N^0MICS    IN   WAR 

dictated  by  considerations  of  flavor.  Opinions  are  occasionally  divided 
as  to  the  place  of  this  sugar  in  the  dietary.  Mendel  is  of  the  opinion  that 
the  artificially  colored  white  sugar  has  nothing  except  a  false  standard  to 
recommend  it  in  place  of  the  natural  cream-colored  sugar.  It  will  be  ob- 
served that  Mendel  appears  sceptical  as  to  white  sugar  being  of  any  great 
nutritive  value,  but  does  not  comment  on  the  cream-colored  product. 

Campbell,  referred  to  above,  propounded  as  iconoclastic  opinions  with 
regard  to  the  food  value  of  sugar  as  he  propounded  concerning  milk.  He 
stated  that  we  could  get  on  very  well  without  sugar  at  all.  Primitive  man 
had  none  but  the  limited  quantity  furnished  by  wild  honey.  War  prices 
are  exorbitantly  high,  and  it  consequently  behooves  everyone  to  be  eco- 
nomical. He  maintained  that  all  money  spent  on  candy  is  worse  than 
wasted,  and  recommended  that  none  should  he  so  spent,  that  the  money 
saved  in  this  way  shoiild  be  loaned  to  the  state,  and  that  the  multitude 
of  persons  engaged  in  the  sweet  industry  should  be  transferred  to  occupa- 
tions more  profitable  to  the  country. 

More  than  one  well-known  physiological  authority  has  stated  that 
sugar  is  not  a  natural  food,  inasmuch  as  the  human  economy  is  con- 
structed to  convert  carbohydrate,  e.g.,  starch,  which  they  claim  to  be  a 
natural  foodstuff,  into  sugar.  It  is  certain  that  if  sugar  were  tasteless 
or  not  sweet,  it  would  not  be  so  popular  as  it  is,  and  thus  it  must  rank  as 
a  condiment  as  well  as  a  food.  It  is  interesting  to  recall  that  sugar  was 
scarcely  a  commercial  commodity  a  little  over  a  century  ago,  and  that 
before  that  our  ancestors  got  on  very  well  without  it,  while,  as  a  matter 
of  fact,  a  big  section  of  the  community  consumes  nowadays  very  little  or 
none  of  it.  The  history  of  starch  in  the  dietary,  on  the  other  hand,  goes 
back  to  the  very  beginning  of  things,  and  there  was  a  supply  of  starches 
long  before  sugar  was  thought  of  in  its  present  form.    . 

Custom  and  cheapness  have  brought  sugar  into  wide  use,  but  in  time 
of  war  its  emplo^Tuent  in  many  extraneous  and  totally  unnecessary  ways 
should  be  prohibited.  After  all,  diet  is  largely  ruled  by  custom,  and  war 
has  gone  to  show  that  many  customary  articles  of  food  which  were  con- 
sidered essential  by  the  public  cannot  only  be  dispensed  with,  but  be  dis- 
pensed with  to  the  benefit  of  the  general  health. 

Alcohol  in  War  Economics. — The  war  in  Europe  has  had  a  great  effect 
on  the  consumption  of  alcohol.  It  need  hardly  be  pointed  out  that  in  the 
economics  of  war  the  question  of  alcohol  stands  out  most  prominently. 
The  value  of  alcohol  as  a  food  or  even  as  a  fuel  may  be  dismissed  as 
trivial  in  comparison  with  the  harm  that  it  does,  and  the  waste  of  men 
and  food  and  feeding  material  in  its  manufacture. 


USE  OF  CERTAIN  FOODSTUFFS  IN  WAR     767 

The  food  or  fuel  value  of  alcohol  is  so  slight  as  to  be  a  negligible  quan- 
tity. It  has  been  established  that  about  one  ounce  of  absolute  alcohol 
is  the  limit  which  can  be  burned  up  in  the  body  within  a  period  of  twenty- 
four  hours  without  paralyzing  or  narcotic  effect,  and  without  the  appear- 
ance of  unchanged  alcohol  in  the  excreta,  and  one  ounce  of  alcohol  sup- 
plies about  as  much  fuel  as  one  ounce  of  margarin,  200  calories.  Now 
one  ounce  of  alcohol  costs  in  the  form  of  cheap  spirit  not  more  than  four 
cents;  in  the  form  of  beer  less;  in  the  form  of  heavy  wines,  8  to  12  cents; 
in  the  form  of  light  wine,  24  cents ;  while  to  these  prices  must  be  added 
some  40  or  50  per  cent  during  war  time.  One  ounce  of  margarin  costs 
about  2  cents.  Therefore,  even  if  alcohol  is  regarded  as  a  food,  it  is  an 
extremely  wasteful  and  expensive  one. 

Perhaps  the  sudden  withdrawal  of  alcohol  in  any  form  from  those  with 
whom  its  use  has  been  habitual  may  be  followed  by  injurious  eifects  on 
muscular  and  nervous  energy.  It  is  conceivable  that  n^en  who  for  years 
have  been  accustomed  to  taking  some  form  of  alcoholic  beverage  as  a  part 
of  their  diet  after  a  hard  day's  labor,  might  be  aifected  by  its  sudden  and 
complete  withdrawal.  Possibly  in  any  regulations  drawn  up  for  the  re- 
striction or  prohibition  of  the  manufacture  or  sale  of  alcohol,  it  might 
be  deemed  wise  to  make  allow^ance  for  the  cases  of  those  in  whom  total 
abstinence  produces  ill  effects.  There  are  other  difficulties  in  the  way  of 
enforcing  prohibition,  such  as  the  probable  development  of  an  illicit  traffic 
in  alcohol  and  the  introduction  of  substitutes  for  alcohol  which  might  be 
infinitely  more  detrimental  to  public  health  and  order. 

When  all  is  said  that  can  be  said  in  favor  of  alcohol  and  of  the  dis- 
advantages of  its  total  withdrawal,  these  will  weigh  almost  as  nothing 
against  the  obvious  manifest  advantages  of  prohibition  as  a  war-time 
measure.  When  food  is  scarce  and  the  food  situation  serious,  the  question 
of  the  control  of  the  liquor  traffic  becomes  insistent  from  the  point  of  view 
of  national  efficiency.  To  this  argument  may  be  added  the  further  con- 
tention that  the  loss  of  energy  value  involved  in  the  conversion  of  the 
carbohydrate  of  grain  and  sugar  into  alcohol  represents  in  itself  a  serious 
leakage  in  food  supplies.  It  must  be  remembered  that  there  is  an  in- 
evitable loss  of  energy  in  the  conversion  of  these  more  highly  organized 
bodies  into  the  simpler  alcohol ;  only  some  60  per  cent  of  the  energy'  in 
the  barley  grain  or  the  potato  flour  remains  in  the  resulting  beer  or  spirit. 
In  itself  brewing  or  distilling  is  a  gross  waste  of  food  products. 

By  the  enforcement  of  total  abstinence  at  a  stroke,  the  consumption 
of  the  thousands  of  tons  of  grain  employed  in  the  manufacture  of  beer 
and  spirits  would  be  saved,  a  vast  amount  of  energ;;^'  now  employed  in 


768 


FOOD   ECONOMICS    IN   WAR 


brewery,  distillery  and  saloons  would  be  diverted  into  more  profitable 
channels,  and  the  health  and  morals  of  the  nation  would  be  raised.  By 
the  cessation  of  the  manufacture  of  alcohol,  and  the  utilization  of  its  raw 
materials,  especially  of  potatoes  and  grain,  as  immediate  sources  of  food 
supply,  the  strain  of  providing  the  population  with  nutriment  will  be,  to 
that  extent,  relieved. 

For  industrial  and  scientific  purposes,  alcohol  is  valuable,  and  to  sup- 
ply the  needs  in  this  direction,  the  manufacture,  perhaps,  of  a  limited 
amount  should  be  permitted.  But  so  far  as  beverage  is  concerned,  the 
war  has  taught  the  lesson  that  human  efficiency  can  be  maintained  at  a 
higher  standard  without  alcohol  than  with  it. 

The  Food  Situation  in  the  United  States. — More  food  is  produced  in  this 
country  than  in  any  one  country  of  the  world,  and  yet  at  the  present  time 
there  is  a  food  shortage.  This  shortage  is  due  to  many  causes:  (a)  Food 
production  has  not  kept  pace  with  the  growth  of  population  and  has  been 
giving  alarm  to  agricultural  experts  for  several  ^^ears.  During  the  past 
three  decades  Americans  have  been  forsaking  the  farms  for  city  life,  and 
as  a  consequence  agricultural  labor  has  been  becoming  more  and  more 
difficult  to  obtain.  Thus  the  food  problem  has  been  greatly  hampered  by 
the  lack  of  agricultural  workers,  and  this  has  been  especially  noticeable 
since  the  outbreak  of  the  great  European  War.  (b)  The  opportunity  for 
securing  employment  in  manufacturing  establishments,  the  consequent 
high  rate  of  wages  and  the  inducements  of  city  life  have  enticed  many 
agricultural  workers  to  forsake  the  farm,  which  has  seriously  interfered 
with  the  necessary  labor  for  agricultural  work  and  has  added  much  to 
the  serious  phases  of  agricultural  pursuits. 

Since  1884  the  production  of  wheat  in  this  country  has  dropped  a 
very  considerable  extent,  due  to  the  inability  of  the  farmer  to  procure  the 
necessary  help.     Farmers  are  now  killing  their  live  stock  and  as  a  conse- 


CEREAL  PRODUCTION  OF  THE  UNITED  STATES  IN  1915 


Cereal 

Acreage 

Bushels 

Corn 

108,321,000 

59,898,000 

40,780,000 

7,565,000 

2,856,000 

806,000 

694,000 

3,054,535,000 

Wheat 

1,011,505,000 

Oats 

1,540,362,000 

Barley 

237.009,000 

Rye     

49,190,000 

Buckwheat 

15,769,000 

Rice 

65,691,700 

USE    OF    CEliTAlN    FOODSTUFFS    m    WAR  769 

qiienee  supplies  of  meat  in  cold  storage  liave  fallen  off  enormously.  The 
high  prices  of  all  kinds  of  foodstuff  since  the  beginning  of  the  European 
War,  have  resulted  in  a  very  marked  increase  in  the  export  of  all  food- 
stuff, which  unfortunately  does  not  signify  an  increased  ability  to  produce 
food,  but  on  the  other  hand  means  rather  that  we  are  depleting  our  exist- 
ing stock  of  supplies. 

In  1016,  harvest  conditions  in  the  United  States  were  much  below 
normal  production  and,  in  short,  it  has  been  plainly  demonstrated  that  our 
reserves  in  cereal  grains  are  being  rapidly  exhausted.  It  has  been  com- 
puted that  our  Allies'  cereal  crop  this  year  has  shrunk  to  about  525,- 
000,000  bushels  below  normal,  and  if  consumption  in  the  allied  coun- 
tries is  to  be  maintained  at  or  near  normal  no  less  than  1,250,000  bushels 
of  grain  must  be  exported  by  the  United  States.  The  cattle  and  hogs  in 
the  allied  countries  are  diminished  in  number  by  something  like  30,- 
000,000  head,  and  these  reductions  will  continue  with  increasing  severity 
for  the  reason  that  animals  must  be  slaughtered  on  account  of  shortage 
in  food  supplies.  We  have  not  only  to  feed  the  people  of  our  own  coun- 
try, but  we  are  also  expected  to  make  up  the  food  deficiency  of  our 
Allies,  and  thus  the  burden  of  the  war,  so  far  as  supplying  subsistence 
to  the  Allied  armies  is  concerned,  falls  most  heavily  on  the  United 
States. 

If  tbis  war  is  to  be  won  by  our  Allies,  food  must  be  strictly  conserved 
by  the  American  people.  We  shall  consider  briefly  the  food  problem  from 
an  economic  viewpoint.  It  may  be  safely  said  that  our  own  people,  up 
to  the  present  time,  seem  to  have  failed  to  realize  adequately  the  all- 
important  role  that  food  will  play  in  this  war  and  there  is  grave  danger 
in  the  fact  that  the  necessity  for  economy  in  diet  is  not  sufficiently  appreci- 
ated. It  has  been  pointed  out  in  a  previous  section  of  this  chapter,  that 
under  the  compelling  stress  of  circumstances,  the  nations  at  war  in 
Europe  have  restricted  and  regulated  the  consumption  of  food,  and 
avoided  waste  in  every  possible  way,  and,  moreover,  that  up  to  a  certain 
point,  this  has  been  done  with  correspondingly  decided  benefit  to  the 
public  health.  As  a  matter  of  fact,  economy  in  diet  in  this  country,  if 
arranged  on  sensible  and  scientific  principles,  should  be  attended  with 
little  or  no  injurious  effects  on  the  health  of  the  population.  Such  econ- 
omy may  be  uncomfortable  for  a  time,  but  man  is  extraordinarily  adapt- 
able, and  in  a  short  time,  provided  he  gets  a  sufficient  quantity  of  fat  and 
energy-producing  foods  in  well-balanced  proportions  to  keep  the  human 
machine  working,  it  does  not  matter  much  whether  his  subsistence  is 
derived  mainly  from  the  vegetable  or  animal  kingdom.     As  previously 


770  FOOD    ECONOMICS    IN    WAR 

pointed  out  in  this  work  Americans  are  large  meat  eaters  but  so  were 
the  Germans  and  British  before  the  war. 

The  Germans  and,  to  a  lesser  extent,  the  British,  have  denied  them- 
selves meat  with  a  good  deal  of  philosophy  and  with  benefit  rather  than 
harmful  results.  Educational  propaganda  with  regard  to  food  economy  in 
this  country  should  not  only  dwell  on  the  need  for  economy  and  self- 
denial,  but  should  lay  special  stress  upon  the  point  that  comparative  de- 
privation of  meat  and  the  substitution  of  nutritious  articles  of  food  for 
those  to  which  the  population  has  by  long  use  become  accustomed,  invokes 
no  special  hardships,  while  in  many  instances  a  restricted  diet  may  be 
beneficial. 

In  the  first  place  the  foodstuffs  exported  by  us  must  be  of  a  most  con- 
centrated kind,  as  for  example,  wheat,  beef,  pork,  dairy  products,  fats 
and  sugar.  Although  we  have  a  surplus  of  potatoes,  vegetables,  fish  and 
poultry,  these,  with  the  exception  of  vegetables  in  dehydrated  form,  do 
not  lend  themselves  to  shipment. 

As  said  before,  the  wheat  supply  is  short  and  the  food  administrator 
has  requested  the  population  of  this  country  to  eat  corn  bread  and  conserve 
the  wheat  for  our  Allies.  Corn  meal,  when  properly  prepared,  can  be 
made  as  nutritious,  as  wholesome,  and  as  palatable  as  wheat  bread.  We 
are  the  largest  corn  growing  nation  in  the  world  and  our  people,  unlike 
the  Frenchmen  and  Englishmen,  are  not  averse  to  eating  corn  bread. 
Accordingly  the  first  logical  step  in  adapting  our  food  supplies  and  con- 
sumption to  the  needs  of  our  Allies  is  to  substitute,  as  far  as  possible,  corn 
for  wheat  on  our  own  tables.  Furthermore,  when  wheat  bread  is  placed 
upon  the  table  it  should  be  baked  from  whole  wheat  meal.  The  bread 
on  which  our  sturdy  grandsires  throve  was  made  from  the  whole  wheat 
berry  and  the  ingenuity  of  man  has  never  devised  a  more  wholesome,  more 
palatable  nor  more  nutritious  bread  than  that  made  from  the  whole  wheat 
grain.  This  point  has  been  previously  dwelt  upon  in  other  portions  of 
this  work.  The  reasons  why  whole  wheat  flour  should  be  used  are  as  fol- 
lows: When  properly  made  and  baked,  bread  made  from  whole  wheat 
flour  is  more  nutritive  and  digestible  than  bread  made  from  highly  milled 
and  finely  bolted  Avhite  flour;  besides  it  contains  all  of  the  cereal  salts 
(1.75  per  cent),  while  highly  bolted  white  flour  is  deficient  in  cereal  salts 
(only  .44  per  cent).  Moreover,  the  modern  patent  roller  process  flour 
is  deficient  in  vitamines,  while  the  whole  wheat  flour  contains  all  of  the 
vitamines  which  nature  grew  into  the  wheat  berry. 

Graham  Lusk,  who  has  devoted  much  research  to  the  subject  of  scien- 
tific nutrition,  advocates  the  consumption  of  graham  (whole  wheat)  bread. 


USE  OF  CERTAIN  FOODSTUFFS  IN  WAR     771 

and  several  authorities  on  nutrition,  both  in  this  country  and  in  Europe, 
are  enthusiastic  over  the  nutritive  properties  of  whole  wheat  bread.  In 
fact,  just  a  few  months  ago  an  edict  went  forth  in  Great  Britain  that  all 
flour  should  be  ground  from  the  whole  wheat  grain.  A  feature  in  favor 
of  whole  wheat  meal  is  that  bread  made  from  it  requires  more  mastication 
and  exerts  a  considerably  more  laxative  effect  than  bread  made  from 
highly  bolted  patent  roller  process  flour  which  predisposes  to  constipation 
and  intestinal  stasis,  complaints  which  are  widely  prevalent  in  this  coun- 
try. However,  the  advantages  of  whole  wheat  bread  have  been  sufficiently 
emphasized. 

The  question  of  protein  consumption  has  given  rise  to  considerable 
discussion,  or,  perhaps,  it  is  more  correct  to  say  that  the  discussion  has 
hinged  on  the  point  as  to  which  form  of  protein  should  be  taken  as  food. 
There  is  virtually  no  difference  of  opinion  with  regard  to  the  need  of 
protein.  To  a  greater  or  lesser  extent,  it  is  known,  that  on  the  whole, 
more  protein  in  the  form  of  meat  is  eaten  than  is  physiologically  required. 
It  certainly  is  a  fact  that  owing  to  the  false  teaching  and  long  held  beliefs 
of  the  strengthening  effects  of  meat,  too  much  meat  is  consumed  by  both 
young  and  old  with  harmful  results  to  both.  This  subject  has  been  previ- 
ously considered  and  we  will  not  enter  into  a  dissertation  here  regarding 
protein  as  a  food ;  it  will  suffice  to  say  that  the  protein  of  meat  can  be  re- 
placed by  vegetable  protein,  such  as  that  from  the  legumes,  whole  wheat 
flour,  and  various  vegetables.  These  are  cheaper  by  far,  more  easily  and 
economically  produced,  and  will  maintain  the  body  at  a  high  standard  of 
efficiency  and  health;  therefore,  the  next  step  in  the  direction  of  food 
economy  is  to  substitute,  as  far  as  possible,  protein  from  the  vegetable 
kingdom.  Moreover,  fish  can  be  largely  used  as  a  substitute  for  meat  and 
we  have  fish  in  great  abundance. 

Unfortunately  the  fat  content  of  a  well-balanced  ration  is  not  trans- 
mutable.  No  substitute  can  be  offered  in  the  place  of  fats,  but  some  very 
useful  advice  can  be  tendered.  A  large  reduction  in  the  ordinary  con- 
sumption of  fat  by  the  well-to-do  citizen  will  be  helpful  to  the  nation  and 
to  the  individual.  Graham  Lusk,  writing  in  the  Scientific  Monthly, 
October,  1917,  draws  attention  to  the  fact  that  it  is  not  at  all  difficult 
to  reduce  the  body  weight  by  reducing  the  consumption  of  fats  and 
starches  and  cutting  down  the  energy  value  of  their  ration  from  2,800 
calories  to  about  2,200  calories.  The  fuel  foods  for  the  human  machine 
are  principally  made  from  wheat,  corn,  rice  and  the  sugar  cane. 

The  average  American  consumes  more  sugar  than  is  necessary  or 
beneficial  and  if  we  are  to  be  able  to  export  any  sugar  to  our  Allies  the 


772  FOOD    ECONOMICS    IN   WAR 

per  capita  consumption  must  be  reduced  in  this  country.  This  is  one 
aspect  of  the  food  situation  in  this  country  which  has  not  been  met  as  it 
should  have  been  met. 

The  author,  at  the  outbreak  of  the  war,  suggested  that  the  use  of 
grains  for  the  manufacture  of  intoxicating  beverages  should  be  stopped. 
The  grain  that  is  now  being  used  for  the  manufacture  of  intoxicating 
drinks,  if  employed  for  human  consumption  or  for  fodder  for  animals, 
would  relieve  the  present  stress  to  an  unbelievable  degree.  The  employees 
thrown  out  of  work  by  prohibition  would  soon  find  other  spheres  of  human 
endeavor  in  which  they  would  be  much  more  useful  to  the  community. 
The  greatest  source,  perhaps,  for  the  inflation  of  the  prices  of  foodstuffs 
is  the  present  manipulation  of  the  food  markets  by  sj^eculation.  And 
another  point  in  the  present  high  cost  of  living  and  bad  food  preparation 
is  a  want  of  knowledge  in  the  culinary  department.  For  a  couple  of 
decades  past  the  science  of  cookery  has  not  been  taught  in  the  home  as  it 
should  be,  and  as  a  result  the  daughters,  with  the  exception  of  a  few  who 
have  been  trained  in  domestic  science  schools,  are  unacquainted  with  the 
uses  of  the  culinary  utensils  of  the  modern  household. 

Lusk,  referred  to  previously,  formulates  the  following  propositions, 
which  are  so  apropos  to  the  subject  that  no  excuse  for  quoting  them  is 
necessary:  "(a)  Eat  corn  bread  and  save  the  wheat  for  France  and  our 
other  Allies;  (b)  Let  no  family  of  five  persons  buy  meat  until  it  has 
bought  three  quarts  of  milk;  (c)  Save  the  cream  and  butter  and  eat  vege- 
table oils  and  oleomargarin ;  (d)  Eat  meat  sparingly,  rich  and  poor, 
laborer  and  indolent  alike;  (e)  Be  a  prohibitionist  for  the  period  of  the 
war;  (/)  Save  everything  that  can  be  used  for  food,  because  food  is 
precious;  (g)  Finally,  remember  that  the  whole  world  is  seeking  for 
food  with  which  to  work  and  although  our  wheat  crop  is  short,  still  we 
are  the  nation  most  richly  endowed  with  fuel  food.  It  remains  to  be 
seen  whether  we  have  the  intelligence  to  fitly  utilize  for  the  welfare  of 
mankind  the  resources  which  God  and  nature  have  placed  in  our  hands." 

The  only  solution  of  the  food  problem  is  to  eat  more  of  the  foods  which 
can  be  easily  raised  and  less  of  those  which  are  so  urgently  needed  by  our 
Allies.  As  our  food  dictator  has  stated,  "There  is  no  real  conservation 
without  reduction  in  consumption,  and  the  elimination  of  personal  waste." 

If  the  people  of  this  country  will  heartily  cooperate  with  the  food 
conservator  in  the  endeavor  to  conserve  the  food  supply,  and  will  endure 
for  a  while  some  discomfort,  there  will  be  no  difficulty  regarding  the  food 
problem.  Sufficient  food  can  be  produced  to  keep  the  population  supplied 
with  a  well-balanced  dietary  with  sufficient  to  export  for  the  Allies.     The 


SUMMARY  773 

case  of  Germany  has  plainly  demonstrated  this  fact,  but  in  this  country 
the  populace  must  be  educated  with  resi>ect  to  scientific  nutrition  and 
must  come  to  realize  that  personal  selfishness  must  be  subordinated  to  the 
national  interest. 

SUMMARY 

As  remarked  in  the  introductory  sentences  of  this  chapter,  the  author 
is  of  the  opinion  that  in  a  work  on  diet,  notice  should  be  taken  of  the  food 
question  in  war,  and  that  an  attempt  should  be  made  to  extract  whatever 
lessons  in  this  direction  might  seem  apposite. 

The  conclusions  to  be  drawn  as  the  result  of  this  survey — for  it  can 
hardly  be  termed  a  close  study — are:  That  the  limitation  of  food  conse- 
quent upon  a  short  supply  brought  about  by  war  conditions  is  beneficial 
to  a  certain  proportion  of  the  population,  further  demonstrating  the  fact 
that  in  the  ordinary  way  the  majority  of  persons  eat  more  than  their  phys- 
iological requirements  call  for.  On  the  other  hand,  a  restricted  food  sup- 
ply presses  heavily  on  those  least  able  to  bear  the  pressure,  that  is,  on  those 
who,  on  account  of  the  greatly  enhanced  price  of  food,  are  unable  to  obtain 
the  kind  of  diet  to  which  they  are  accustomed  and  indeed  suffer  from  a 
paucity  of  nutritive  elements.  It  seems  to  have  been  proven  that  over- 
feeding is  injurious,  but  that  underfeeding  is  worse. 

So  far  as  the  different  essential  constituents  of  the  food  are  concerned, 
at  the  time  of  writing  it  is  impossible  to  speak  dogmatically.  It  appears 
to  have  been  demonstrated  that  more  protein  is  generally  eaten  than  is 
needed,  and  not  enough  fat.  The  Germans,  according  to  Taylor,  suffered 
from  the  limitation  of  fat  in  their  diet,  and  it  may  be  stated  that  fat  is 
a  more  important  factor  in  the  promotion  of  physical  efficiency  than  hith- 
erto has  been  believed.  One  of  the  chief  lessons  learned  from  the  war 
so  far  has  been  the  great  economical  and  nutritive  value  of  whole-grain 
bread.  The  proven  dietetic  value  of  whole-grain  bread,  and  of  cereals 
from  which  the  husks  have  not  been  removed,  suggests  the  reflection  that 
possibly  the  value  of  food,  after  all,  depends  no  more  on  its  protein,  fat 
or  carbohydrate  content,  as  the  case  may  be,  than  on  the  possession  of  those 
food  elements  termed  vitamines.  Certain  it  is  that  when  these  are  absent, 
ill  health  and  disease  are  generally  the  sequence. 

In  this  chapter  some  opinions  have  been  expressed  with  regard  to  milk 
which  do  not  seem  to  be  in  accord  with  the  views  of  authorities.  The  opin- 
ions propounded  here,  while  not  entirely  those  of  the  author,  still  are  his 
to  this  extent,  that  he  does  believe  that  milk  per  se  is  not  an  indispensable 
article  of  diet  except  for  infants,  and  that  the  best  use  that  can  be  made 

149 


774  FOOD    ECONOMICS    m    WAK 

of  milk,  in  war  time  at  any  rate,  is  its  conversion  into  cheese,  otie  of  the 
most  wholesome  and  nutritive  foods  known.  A  good  hunch  of  crusty 
bread,  with  butter  and  cheese  or  fat  bacon,  followed  by  a  little  raw  fruit, 
such  as  an  apple,  constitutes  a  well-balanced  meal. 

It  has  been  pointed  out  that  the  question  of  sugar  is  a  vexed  one.  In 
England  it  appears  to  have  been  concluded  that  its  dietetic  virtues  have 
been  exaggerated,  and  that  in  war  time  its  consumption,  with  great  benefit 
to  all  concerned,  might  be  very  considerably  restricted.  With  regard  to 
the  liquor  traffic  in  war  time,  there  is  and  should  be  very  little  difference 
of  opinion.  The  grain,  potatoes,  etc.,  that  are  employed  in  the  manufac- 
ture of  alcohol  in  war  time  should  be  utilized  for  feeding  men  and  animals 
and  in  every  respect  the  manufacture  of  alcohol  to  be  used  as  a  beverage 
should  be  restricted  to  a  minimum  or  wholly  interdicted. 

Finally,  there  are  at  least  four  ways  of  reducing  the  consumption  of 
food :  1.  By  preparing  the  food  in  the  most  economical  way.  2.  By  mini- 
mizing waste.  3.  By  selecting  the  right  kinds  of  food  and  in  the  right 
proportions.  4.  By  limiting  to  a  sufficiency  the  quantity  of  food  con- 
sumed. 

REFERENCES 

1.  Taylor,  A.  E.    Saturday  Evening  Post,  Feb.  IT,  1917. 

2.     .     Ibid.,  Apr.  14,  1917. 

3.  British  Medical  Journal,  Feb.  17,  1917. 

4.  Waller,  A.  D.    Lancet,  Feb.  17,  1917,  p.  273. 

5.  Mendel.     Changes  in  the  Food  Supply  and  Their  Relation  to  Nutri- 

tion. 

6.  Campbell.     Lancet,  Apr.  1,  1916. 


INDEX 


A 


Absorption,  of  end  products  of  protein  di- 
gestion,   ill-effects  of,    198. 
Acid-forming   and   base-forming   elements, 

314. 
Acid-forming  elements  of  diet,  357. 
Acidosis,  due  to  chronic  intestinal  stasis, 

4(53. 
Acne,  diet   in,   4(j7. 
Aerophagv,  treatment  of,   122. 
Akoria,    121. 

Albumin,   purin-free  diet  to  supply,  330. 
Albumins,   coagulation   point  of,   57. 
Aloumin  water,  preparation  of,  580. 

egg,   preparation  of,   581. 
Albuminized     lemonade,     preparation     of, 

579. 
Albuminized  milk,  preparation  of,  583. 
Albiuninous  bodies,  in  breast  milk,  477, 
Albumimiria,  in  pregnancy,  diet  in,  466. 
Alcohol,  as  a  beverage  or  as  a  medicine, 
401. 
effect  of,   385. 
as  a  food,  406. 
as  a  protein  sparer,  306. 
use  of,  385,  401. 
in   puberty,  420. 
in  tropical  climates,  401. 
in  war,  766. 
utilization  of  different  food  stuffs  with 
and  without,  308. 
Alimentary  hygiene.     See  Eating,  hygiene 

of. 
Alkali,  added  to  milk,  to  prevent  clotting, 

494. 
Allotriophagia,   119. 
Almond  milk,  preparation  of,  582. 
Amino-aeids,  deaminization  of  proteins  in, 
169. 
in  proteins,   194. 

qualitative  variations  of,  200, 
as  reserve  energy  supply,   211. 
ultimate    fate    oi,    after    absorption    by 
tissues,  210. 
Ammonia,  in  protein  metabolism,  329. 
Anabolism,  definition  of,  286. 
Aneurisms,  IScllingham's  diet  for,  548. 

Tufneli's  di.'t    for.  547. 
Animal   ]ir()tein,  vegetable  protein  versus, 

528. 
Anorexia,  120. 

775 


Appetite,   loss  of,   120. 

perversions  of,  akoria,  121. 
anorexia,   120. 

bulimia,  or  hyperorexia,  120. 
parore.xia,  119. 
polydipsia,  121. 
polyphagia,   121. 
rumination,    121. 
seasickness,  122. 
"Apple-fasts,"  545. 
Apples,   dried,   25. 
Apple  water,  preparation  of,  578. 
Apricots,  dried,  24. 

Army    rations,    foreign.      See   Rations,   of 
foreign  armies. 
U.  S.     See  Rations,  U.  S.  Army. 
Arteries,   hardening  of,   sign   of  old   age, 

434. 
Arteriosclerosis,  and  old  age,   439. 

as  sign  of  old  age,  434. 
Arthritis,  rheumatoid,  due  to  chronic  in- 
testinal stasis,   460. 
Ash,  percentage  of,  in  bones,  muscles  and 

various  organs,  312. 
Atwater's    experiment    for    calculation    of 

energy  metabolism,  296. 
Austria,  army  daily  ration  of,  715. 

B 

Bacltz's  investigations  among  the  Japan- 
ese, in  regard  to  diet  and  endur- 
ance, 176. 
Baking    of    meat,     comparison    of,     with 
roasting,  60. 
mechanical  and  chemical  changes  in,  60. 
as  practised  by  savage  tribes,  60. 
process  of,  60. 
Banana  figs,  27. 
Bananas,  dried,  27. 

dried  products  of,  27. 
Barley  water,   preparation  of,  580. 
Base-forming  and   acid-forming  elements, 

314. 
Base-forming  elements  of  diet,  367. 
Beans,  dehydrated,  41. 
cooking  of,  43. 
food  value  of,  44. 
dried,  41. 

composition  of  fresh  and,  41. 
lima,  deliydrated,  42. 
soy,  dehydratwl,  42. 
Beef  broth.   ])reparation  of.     See  Recipes, 
broths. 


776 


INDEX 


Beef,  dried,  2. 

Beef  essence,  preparation  of.    See  Recipes, 

meat  juices. 
Beef  juice,   preparation   of.     See  Recipes, 
meat  juices, 
peptonized,  preparation  of,  589. 
Beef  tea  egg-nog  ( Davis ) ,  preparation  of, 
587. 
preparation  of.     See  Recipes,  beef  teas. 
Beets,  dehydration  of,  36. 

advantages  of,  37. 
Beet-sugar  industry,  36. 
Bellingham's  diet   for   aneurisms,  548. 
Beriberi,   due   to    lack  of   vitamines,   230. 
Berries,  drying  of,  27. 
Bevenot  de  neveu  process  of  desiccation  of 

miJk,  13. 
Beverages,    preparation   of.      See   Recipes, 
beverages, 
in  tropical  climates,  405. 
Bile,  secretion  of,  in  underfeeding,  162. 
Biliousness,  due.  to  overeating,   135. 
Biltong,  or  dried  beef,  2. 
Blood,  effect  of  underfeeding  on,  162. 
Body  weight,  protein  minimum  necessary 

to,  table  showing,  154. 
Boiling  of  fish,  66. 
of  meat,  55. 

action  of  salt  in  water,  57. 
for  broth  or  bouillon,  56. 
correct  procetlure  for,  56. 
difference  between  stewing  and,  57. 
effect  of,  55. 
primitive  method  of,  55. 
Borax,  use  of  in  rreservation  of  meats,  7. 
Bouillon,  procedure  for  making,  56.     See 

also   Recipes,   bouillons. 
Boys'    military    training    camps,    rations 
for.     See  Rations,  for  Boys'  Mili- 
tary Training  Camps. 
Bradyphagia,   82. 

advocates  of,  Fletcher,  82. 

Gladstone,  83. 
definition  of,  83. 
ill  effects  of,  84,  85. 
Braising  of  meat,  64. 
Brandy  and  egg  mixture,  preparation  of, 

586. 
Bread,  advantages  of  wholemeal  over  high- 
ly milled,  749. 
use  of,  in  war,  759. 
Bread-making,  history  of,  49. 

See  Recipes,  breads. 
Breast  feeding,   age  for,  481. 
axioms  for,  481. 
colostrum,  475. 
contra-indications   to,   488. 
daily  bowel  movement  during,  482. 
diet  during  period  of,  481. 
duration  of  weaning,  483. 
gain  in  weight  after  each  meal,  485. 
galactagogues,  479. 

importance    of    weighing    baby    during 
period  of,  485,  486. 


Breast    feeding,    increased    percentage    of 
mothers  capable  of,  471. 
indications  for  discontinuing,   485,   486. 
micro-organisms  in  milk,  474. 
necessity  for  intelligent  mothers,  480. 
a  normal  function,  482. 
regularity  of,  483. 
relative  frequency  of,  472. 
stimulation  of  lacteal   secretion,  479. 
successful,  484. 
unsuccessful,  484. 

women  of  to-day  better  fitted  for,  472. 
Breast  milk,  coagulation  of,  477. 

comparative  analysis  of  cow's  milk  and, 

490. 
consideration  of,  485. 
constituents  of,  albuminous  bodies,  477. 
casein,  478. 
coagulation,  477. 
fat,  478. 

ferments   (enzymes),  479. 
lactose,  478. 
deficiency  in  proteins  and  fats,  487. 
indications  for  analysis  of,  485. 
lack  of  uniformity  in,  487. 
micro-organisms  in,  474. 
nitrogenous  substances  in,  475. 
quality  of,  485. 
quantity  of,  476. 

daily  average  drawn  by  baby,  477. 
daily     secreted     by     healthy     young 

mothers,  476. 
in  secretion  by  primipara  and  multi- 
para, 476. 
Broiling  of  meat,  63. 
Bronchitis,  of  the  aged,  diet  in,  452. 
Broth,  procedure  for  making,  56.    See  also 

Recipes,  broths. 
Bulimia,  120. 

Butter-fat,  and  vitamines,  228. 
Buttermilk,  in  infant  feeding,  chief  value 
of,  501. 
class  of  infants  benefited  by,  501. 
composition  of,  500. 
origin  of,  500. 
preparation  of,  500. 
Buttermilk  cure,  566. 
Buttermilk  and  egg  mixture,  preparation 
of,  584. 


Cabbage,  dehydrated,  40. 
Cactus  fruit,   dried,  28. 
Calcium  content  of  foods,  350,  351. 
Calcium  excretion,  349, 

lowering  of,  in  disease,  341. 
Calcium     oxid,     in     foods,     approximate 

amounts  of,  353. 
Calcium  salts,  importance  of,  349. 
in  infancy  and  childhood,  350. 

ingestion  of,  349. 


INDEX 


777 


Caloric  method  of  footling,  calculation  of 
fuel  values  of  food,  257. 
comparative  equivalents  in  metric, 
avoirdupois  and  apothecaries' 
weights  and  measures,  257. 
heat  produced  from  substances  burned 
in  calorimeter  distinguished  from 
heat  available  when  used  in  body 
263.  ^' 

represented  by  a  particular  menu,  263. 
table  of,  258-263. 

caloric  requirement  of  man,  252. 

caloric  values  of  ingested  foods,  250. 

calorific  value  of  excretory  products, 
254. 

constructive   and   fuel   foods,   251, 

food  requirement,  factors  governing, 
265. 

heat  of  combustion  of  various  sub- 
stances and  foods,  247. 

introductory,  243. 

method  of  reckoning  the  protein,  fat 
and  carbohydrate  rations  for 
diets  of  definite  energy  values, 
264. 

physiological  food  value,  255. 
regulation  of  body  temperature,  274. 
standard  and  sample  dietaries,  248. 
unit  and  method  of  measurement,  246. 
Caloric  requirement  of  man,  252. 
Calories,   income   and   outgo   of,   in  meta- 
bolism experiments,  291. 
Calorific  value  of  excretory  products,  254. 
Rubner's  table  showing  losses  and  avail- 
able energy,   255. 
Calorimeter,  forms  of,  246. 

use  of,  246. 
Calorimetric    combustion,   average  results 
of,  247. 
heats   of,    and    approximate  elementary 
composition      of      typical      com- 
pounds, table  of,  249. 
Canned  foods,  in  diet  of  tropical  climates, 

400. 
Canning,  chemical  agents  used  in,  7. 
process   of,   for   preservation  of  food,  6. 
other  foreign  nations,  178. 
Carbohydrate    diet,    people    subsisting   al- 
most entirely   on,  Japanese,    176. 
Carbohydrate     and     fat,     Kayser's     table 
showing    nitrogen    balance    when 
feeding  isodynamic  quantities  of, 
303. 
sparing    power   of,    in    calorimetric    ex- 
periments   ( Atwater ) ,  304. 
Carbohydrate-free  diet,  338. 
Carbohydrates,    amount   of,    contained    in 
vegetables,  before  and  after  cook- 
ing of.  69. 
contained   in  cow's  milk,  494. 
easily  burned,  catabolism  of  furnishing 

too  much   heat,  342. 
excess  of,  in  metabolism  of  overfeeding, 
138. 


Carbohydrates,     fat     versus,     as     protein 
sparers,  302. 
function  of,  in  nutrition,  301. 
as  protein  sparers,  300. 
transmutability  of,   101. 
Carbon,  income  and  outgo  of  nitrogen  and, 
in   metabolism   experiments,   290, 
296. 
Carrots,  dehydration  of,  37. 
Casein,  in  breast  milk,  478. 
in  cow's  milk,  493. 
dehydration  of,  17. 
Catabolism,  definition  of,  287. 
Candle,  preparation  of,  581,  587. 
Celery,  dehydration  of,  40. 
Cellulose  diet,  339. 
Cellulose,   foods  containing,  340. 
Cereal  foods,  preparation  of.    See  Recipes. 
Cereal  grains,  exhaustion  of  reserve  in,  in 

U.  S.,  769. 
Cereals,     partly     digested,     prepared     at 
table,  589. 
protein  and  starch  equivalents  in  buck- 
wheat   and,    in    diet    of    tropical 
climates,  table  of,  391. 
use  of,  in  war,  corn,  763. 
oatmeal,  762. 
wheat,  759. 
Certified  milk,  489. 
Character,  infiuence  of  diet  on,  370. 
Chemical     agents,     antiseptic,     treatment 
with,  in  preservation  of  food,  7. 
Chemical  elements,  composing  human  or- 
ganism, 361. 
Chestnut,  dried,  28. 
Chicken  broth,  preparation  of,  598. 
Childhood,  diet  in,  409.     See  also  Diet  in 

Childhood. 
Chinese  raisins,  28. 

Chittenden's    experiments    in    low   protein 
diet,   171. 
conclusions  of.  186,  190. 
Chittenden's  low  protein  dietary,  253. 
Chittenden's  table,  173. 
Chlorin  equilibrium,  maintenance  of,  348. 
Church's  standard  diet  for  Indians,  .393. 
Climate,  and  diet,  372. 

maintenance    allowance    according   to 
climates,  373. 
tropical,  diet  in.     See  Diet  in  Tropical 
Climates. 
Cocoa,  preparation  of,  582. 
Coffee,  preparation  of,  582. 
Cold  storage,  preservation  of  meat  by.  3. 
prolonged,   effect  of,  4. 
requisite  temperatures  for  preservation 
of  certain  animal  foods,  5. 
Colo.strum,  appearance  of,  475. 
composition  of,  475. 
specific  gravity  of,  476. 
Concentrated   proteins,   70. 
Condensed  foods,  as  means  of  food  concen- 
tration, 70. 
Condensed  milk,  in  infant  feeding,  499. 


778 


INDEX 


Constipation,    ancient    usage    of    medical 
practice   for   overcoming   of.   457. 
Constitution,    influence  of   diet  on,   .'JC8. 
Convalescents,  exchange  of  energy  in,  141. 
flesh  formation  in,   141. 
intercliange    of    nitrogen    and    storage, 
protein  and  fat,  absolute  and  per- 
centage,     in     overfeeding,     table 
showing   approximate    values    of, 
143. 
nitrogen   increase   in,    due    to   overfeed- 
ing, table  emphasizing,  142. 
nitrogen  retention  in,  141. 
Cookery,  varieties  of,  54. 
Cooking,  changes  produced  by,  53. 

coagulation  point  of  different  albumins, 

57. 
difference  between  French,  English  and 

American,  53. 
of  dried  beans,  43. 
of  fish,  66. 

history  of,  ancient  British,  50. 
berries,  fruit,   etc.,  50. 
as   branch    of   woman's    education    in 

this  country,  51. 
bread-making,   49. 
fish,  50. 
French,  50. 
meats,  50. 
of  meat,  baking,  60. 
boiling,  55. 
braising,  64. 
broiling,  63. 
comparative    composition    before    and 

after,  65. 
comparative  composition  of  water-free 

substance  before  and  after,  66. 
frying,  58. 
grilling,  63. 

"high"  or  slightly  tainted,  62. 
losses  in,  65. 
roasting,  61. 
steaming,  65. 
stewing,  57. 
poor,  evil  effects  of,  54. 
principles  of,  changes  produced  by,  53. 
digestibility,  51. 
foods  requiring,  51. 
knowledge  of,  necessary  to  physician, 

51. 
scientific  application  of  heat,  51. 
scientific  application  of  heat,  to  animal 
foods,  52. 
coagulation  of  proteins,  52. 
dextrinization  of  starch,  52. 
to  fats,  52. 

gelatinization  of  starches,  52. 
to  sugar,  52. 
to  vegetable  foods,  52. 
of  vegetable  foods,  objects  to  be  achieved 

in,  67. 
of  vegetables,  action  of,  67. 

amount    of    carbohydrates    contained, 
before  and   after,   69. 


Cooking,  of  vegetables,  deficiency  of  fat  in 
vegetables    made    up    in    prepara- 
tion of,  for  table,  69. 
gain  of  water  on,  (iS. 
lengths  of  time  required  for,  69. 
Corn,  dehydration  of,  44. 
protein  of,   199. 
relation  of,  to  pellagra,  44. 
use  of,  in  war,  763. 
Cornmeal  mush,  preparation  of,  609. 
Creatinin,  in  protein  metabolism,   329. 
Crime,    relation   of  underfeeding   to,    152, 

153. 
Curds   and    whey   or   junket,   preparation 

of,  592. 
Cures,  buttermilk,  566. 
dry,  561. 
grape,  546. 
kumiss,  564. 
lemon,  546. 
matzoon,  566. 
milk,  569. 
skim  milk,  572. 
sour  milk  cure,  567. 
whey,  573. 
yolk,  563. 
Currant  juice,  preparation  of,  578. 
Custards,    preparation    of.      ^ee  Recipes, 

custards. 
Cutaneous   lesions,   due   to   chronic    intes- 
tinal stasis,  463,  466. 
acne,  467. 
itching  dermatoses,  468. 


Dates,  curing  of,  27. 
Debility,  dietary  for,  564. 
Decomposition  of  food,  causes  of,  1. 
Deficiency   diseases,   due   to  lack   of   vita- 
mines,  230. 
Dehydration,  advantages  of,  9. 
economic,  46 
of  casein,  17. 
of  eggs,  17. 
of  fish,  20. 

of  foods  used  in  the  army,  37. 
of  fruits,  advantages  of,  economic,  30. 
analysis    and    caloric    value   of   dried 

"fruits,  per  pound,  29. 
as  an  ancient  procedure,  20. 
apples,  25. 
apricots,  24. 

by  artificial   drying,  21. 
bananas,  27. 
cactus  fruit,  28. 
chestnut,  28. 

comparative    cost   of   total    niitrients 
and  fuel  value  of  some  fresh  and 
dried  fruits,  31. 
dates,  27. 
litchi  nut  or  Chinese  raisin,  28. 


INDEX 


779 


Dehydration,  of  fruits,  methods  of,  24. 

old-fashioned,  or  liouseiiold  metiiod, 
24. 
olives.  28. 
peaches.  24. 
persimmon,  28. 
preparation  of  fruit  for,  23. 
proper  storage  of,  26. 
prunes,  22. 
raisins,  20. 

small  fruits  and  herries,  27. 
by   sun   drying,  21. 
unusual,  28. 

in   Germany,    10. 
of  meat,    ancient   and   modern   methods 
of,  18. 
as    a    concentrating    and    preserving 

process,  71. 
powdered  meats,  20. 
disadvantages  of,  20. 
Italian  method  for  making,  20. 
Tellier   method  of,   19. 
of   milk.      See    Desiccated   Milk;    also 
Desiccation   of   Milk, 
success  of,  46. 
value  of,  9. 
of  vegetables,   11,  32. 

advantages  of  kiln  method  for,  41. 
beans.  41. 

cooking  of,  43. 
lima,   42. 
soy,  42. 
beets,  36. 
cabbage,  40. 
carrots,  37. 
celery,   40. 
corn,  44. 

importance  of,  as  food,  32. 
as  means  of  food  concentration,  70, 
methods  of,  32. 
onions,  40. 
potatoes,  33. 

composition  of,  34. 
composition  and  fuel  value  of,  un- 
der  various  methods  of  prepara- 
tion. 34. 
methods  of,  33. 
potato   flour,   35. 
relative    weights    of   green    and   kiln- 
evaporated,  40. 
salsify,  37. 

starch-yielding  tubers,  36. 
sweet  potato,  35. 
turnips,  37. 
used  in  the  army,  37. 
vegetable  flours,  use  of,  44. 
of  yeast,  45. 
.S'ef?  also  Desiccation. 
Dehydrator,    most    efficient    form    of,    for 

home  use,  45. 
Denutrition,  temporary,  benefit  of,   115. 
Dermatoses,  itching,  treatment  of,  468. 
Desiccated  eggs,   71. 


Desiccated  milk,  71. 
advantages  of,   16. 
comparison  of  kinds  of,   15. 
reconstruction  of.  for  infants,  15. 
Desiccation,   as  means  of   food  concentra- 
tion, 70. 
of  milk,   from   which   fat   has   been   re- 
moved, 15. 
historical   development  of  process   of, 

12. 
present  methods  of,  Bevenot  de  neveu 
process  of,  13. 
Ekenberg  process,   13. 
Just-Hatmaker  process,    13. 
Stauf  process,   14. 
as  recent  discovery,  12. 
of  vegetables,  as  means  of  food  concen- 
tration, 70. 
Diabetic   foods,   recipes  for.     (S'ce  Recipes, 

diabetic   foods. 
Diastatic  ferment,  in  milk,  497. 
Diet,   acid-forming   and   base-forming   ele- 
ments of,  357. 
in  acne,  467. 
army.     See  Rations. 
Bellingham's,  for  aneurisms,  548. 
carbohydrate-free,  338. 
cellulose,  339. 

character  of,  and  protein  content,  212. 
in  childhood,  adaptation  of,  to  diathesis 
of  child,  413. 
comparative   heights   and   weights   of 

children,  412. 
early,  410. 
factors   of   growth   and    development, 

415. 
for  gouty  diathesis,  413. 
greediness  discouraged,  417. 
important  points,  412. 
rations  required,  409. 

from  four  to  six  years,  411. 
requisite  amount  of  all  foodstuff's,  415. 
requisite  calories  per  kilogram  for  va- 
rious ages,  415. 
for  school  children,  414. 
arrangement  of  meals,  416. 
suitable  dietary,  416. 
Starr's  table  of  dietetic  needs,  410. 
for  tuberculosis,  413- 
Church's  standard  table  of,  for  Indians, 

393. 
climate  and,  372. 

maintenance    allowance    according    to 
climates,  373. 
drv  cure,  561. 
fat-free,  338. 
fruit.     Sec  Fruit  Diet, 
high  protein,  325. 
importance  of  caloric  value  of,  148. 
influence  of,  on  character,  370. 
on  constitution  and  health,  368. 
of.  on  races.  371. 
in  intestinal  stasis,  chronic,  464. 
after  labor,  429. 


780 


INDEX 


Diet,  during  lactation,  429,  481. 

day's  ration  for  nursing  women,  430. 

decrease   or    increase   of    quantity    of 
mammary   secretion,  431. 

rules  formulated  by  Rotch,  431. 
lacto  vegetarian,   521. 
low  protein,  324. 
meat.     See  Meat  Diet, 
during  menopause,  432. 
during  menstruation,  425. 
in  military  prison  camps,  718. 
milk  cure,  569. 

buttermilk  cure,  566. 

kumiss  cure,  564. 

matzoon  cure,  566. 

skim  milk  cure,  572. 

sour  milk  cure.  567. 

whey  cure,  573. 
navy.     .S'ce  Rations, 
nitrogen.     See  Nitrogen  Diet, 
nitrogen  in.    See  Nitrogen  in  diet, 
nitrogen-free,   325. 
non-meat  eating,  Japanese,  176. 

other  foreign  nations,  178. 
and  occupation,  371. 
in    old    age.    according    to    Dr.    Harry 
Campbell,  440. 

according  to  Friedenwald  and  Ruhriih, 
441. 

alimentary  pastes:   food  value,  449. 

in  broncliitis.  452. 

and  condition  of  teeth,  450. 

idiosyncrasy  a  factor  in.  441. 

Kosevi's  maintenance  ration,  443. 

Langworthy's  dietary  standard,  443. 

Maurel's  maintenance  rations,  443. 

meat  consumption,  451. 

nature  of,   439. 

and  nitrogen  metabolism,  444. 
•for  the  obese.  446. 

quantity  of  food,  436.  439. 

raising  caloric  value  of,  448. 

re<luction  of  fuel  value  in,  445. 

Saundby's  daily  dietary,  showing  dis- 
tribution  of  meals,  447. 

suggestions  of  Yeo,  452. 

for  those  leading  vegetative  lives,  446. 

Voit's  dietary  standard,  442. 
during  pregnancy,  425. 

to    insure    small    but    well-developed 
child,  claims  of  Prochownick,  427. 

"longings"  for  various  indigestible  ar- 
ticles. 426. 

in      presence     of     albuminuria     and 
dropsy.  426. 

Prochownick's,   428. 

quantity  of  food.  426. 

theory    of    abundant   phosphates    and 
lime  salts.  427. 

theorv    of    avoiding   fresh   vegetables, 
427. 
for    professional    singers   and   lecturers, 

560. 
protein.     See  Protein  Diet. 


Diet,  during  puberty,  418. 

craving  for  sweets,  420. 
during  puerperium,  428. 
purin,  excess  of,  335. 

low,  336. 
purin-free.  336. 

dinners  suggested  by  Haig's  disciple, 

relation  of,  to  craving  for  salt,  347. 

of  to  scurvy,  358. 
safety  standard  in,   195. 

caution  as  to  protein  deficiency,   196. 
overfeeding,  197. 
undereating,   196. 
Salisbury,  536. 

modified,  537. 
salt-free,  345. 

in  sedentary  occupations,  421. 
comparative  lunches,  423. 
Richards'   ration,   424. 
suitable  dietary,  422. 
training,  552. 

in    tropical    climates,   alcohol    and   bev- 
erages, 401. 
amount  of,  required,  388. 
canned  foods,  400. 

cause   of   digestive   disturbances,   398. 
Church's  standard  diet  for  Indians,  393. 
conclusions  on,  400. 
and  disease,  399. 
fruit,  389. 
Indians,  393,  394. 
meat  eating,  effect  of,  in,  389. 
meats.  395. 
milk,  394. 

of  natives  and  whites,  397. 
nitrogenous    foods,    comparative    im- 
munity of  white  men  due  to  feed- 
ing on,  388. 
lack  of,  among  natives,  388. 
protein  and  starch  equivalents  in  ce- 
reals  and    buckwheats,   table    of, 
391. 

in  pulse,  table  of,  392. 
sweets,  398. 
vegetables,  390. 
views  on,  changes  in,  386. 
Lukis  and  Blackham.  387. 
Woodruff's.  Dr.  Charles,  386. 
Tufnell's    for    treatment   of    aortic    and 

other  aneurisms,  547. 
variety  in,  necessity  for,  94. 
vegetable.    See  Vegetable  Diet. 
Weir    Mitchell,    in    treatment    of    neu- 
rasthenia and  disorders  of  nutri- 
tion  independent  of  organic  dis- 
ease. 549. 
yolk  curC;  563. 
zymotherapy,  538. 
Dietaries,  actual,  380. 

actual    and    standard,   compared,   378. 
company,  in  U.  S.  army  rations,  675. 
of  individuals  allowed  a  "free  choice  of 
food,"  377. 


INDEX 


781 


Dietaries,  of  inhabitants  of  United  States, 
374. 
Playfair's     table    of    requirements    for 

work,  377. 
standard,  248. 

standard  and  actual,  compared,  378. 
standard  daily,  378,  379. 
tropical,  in  U.  S.  army,  G76. 
typfbal,  minerals  in,  daily  quantities  per 
man,  342. 
Dietary,  in  boys'  military  training  camp. 
Fort   Terry,   New   York,   for  one 
week,  686-690. 
showing  requisite  amounts  of  ternary 
food  elements  and  fuel  or  energy 
value  in  calories,  692-697. 
for  debility,  564. 
fat  and  vegetarian.  Wait's,  521. 
of  laborers,  in  United  States,  376. 
low  protein,  Chittenden,  253. 
of  marching  soldiers,  382. 
of  mechanics,  in  United  States,  376. 
of  Mexicans,   383,   384. 
of  negroes,   382,   384. 
in  old  age,  440. 

of  poor  person  in  New  York  City,  show- 
ing  food   elements   and   calories, 
374. 
in  puberty,  419. 
reducing,  559. 
for  school  children,  416. 
for  the  sedentary,  422. 
of  students'  clubs,  374. 
for  tuberculovis  children,  413. 
of  University  boat-crews,  studies  of,  555. 
vegetarian,   Jaffa's,   542. 
vegetarian  and  fat,  Wait's,  528. 
well-balanced,  vitamines  in,  224. 
of  Yale  training  crew,  554. 
Dietary  experiment,  Neumann's,  310. 
Dietotherapy,  alcohol,  use  of,  385. 
definition  of,  361. 
diet  studies,  374. 
general  principles  of,  361. 
amount  of  food  required,  362. 
climate  and  diet,  372. 
influence  of  diet  on  character,  370. 
on  constitution  and  health,  368. 
on  races,  371. 
meals,  composition  of,  366. 

distribution  of,  366. 
occupation  and  diet,  371. 
Diets,   of   definite    energy   values,   method 
of  reckoning  protein,  fat  and  car- 
bohydrate rations  for,  264. 
special,  519. 

standard,    exchange    of    material    with, 
288. 
Diet  studies.     See  pietary  and  Dietaries. 
Digestibility   of   foodstuffs,   104. 
comparison  as  to,  106. 
fats,  105. 

the  finer  the  subdivisions  of  food  in- 
gested, the  larger  the  proportion 
of  nutriments  assimilated,  105. 


Digestibility  of  foodstuffs,  fruits,  108. 
proteins,  107. 
utilization  of  some  of  staple  foodstuffs, 

104. 
vegetable  foods,  107. 
Digestion,  effect  of  manner  of  eating  on, 
bradyphagia,  82. 
euphagia,  78. 

rapidity  of  mastication,  86. 
taehyphagia,  84. 
occupation  and,  94. 
salivarj',  manner  and  time  of,  85. 
sleep  and,  93. 
and  variety  in  diet,  94. 
See  also  eating,  hygiene  of. 
Digestive   disturbances,    in   tropics,    cause 

of,  398. 
Digestive  glands,  action  on,  of  emotional 

excitement,  81. 
Digestive  organs,  evil  effects  of  underfeed- 
ing on,  152. 
Digestive  process,  first  stages  of,  started 
by    pleasurable    smell    and    sight 
and  taste  of  food,  80. 
Dry  cure,  561. 
Drying  of  food,  2.     See  also  Dehydration, 

and  Desiccation. 
Dyspepsia,  meat  diet  in  treatment  of,  535. 

E 

Eating,  abnormally  slow,  or  bradyphagia, 
82. 
effect  of  manner  of,  on  digestion,  brady- 
phagia, 82. 
euphagia,  78. 
food  and  emotions,  79. 
food  and  work,  79. 
rapidity  of  mastication,  86. 
taehyphagia,   84. 
hasty,  or  taehyphagia,  84. 
hygiene  of,  77. 

and  appetizing  ailments,  78. 

effect  of  manner  of,  on  digestion,  78. 

meals,  order  and  frequency  of,  90. 

regularity  of,  92. 
occupation  and  digestion,  94. 
personal  idiosyncrasies,  89. 
principles  involved  in,  78. 
relation  of  medication  to  meals,  96. 
and  sacrifices  in  food,  88. 
sleep  and  digestion,  93. 
variety  in  diet,  94. 
water  drinking  with  meals,  88. 
personal  idiosyncrasies  in,  89. 
proper,  or  euphagia.  78. 
role  of  senses  in  pleasure  of,  75. 
Egg  dumplings,  preparation  of,  607. 
Eggs,  cold  storage.  5. 
dehydration  of,  17. 
desiccated,  71. 
dried,  17.  71. 

preparation  of.    See  Recipes,  eggs, 
preparation     of    beverages    with.       See 
Recipes,  beverages. 


782 


INDEX 


3,  preservation  of,  by  drying,   17,  71. 
Ekenberg   process   of  desiccation  of  milk, 

13. 
Emotions,  food  and,  79. 
Endurance,    Baeltz's   experiments   in   diet 
and,  among  the  Japanese,  176. 
effect  of  protein  diet  on,  192. 
Fisher's   experiments   on   effect  of   diet 

on,  174. 
Fisher's  test  diet  and,   175. 
•    Flint's   observations   on   effects   of  five- 
day  pedestrian  feat  performed  by 
Weston,  183. 
Endurance    tests,    comparative,    Fisher's, 

176. 
Energy,  consumption  of,  in  chronic  mal- 
nutrition, 160. 
expended  by  marching  soldiers,  382. 
and  vegetable  diet,  524. 
Enzymes,  in  breast  milk,  479. 
Epicures,   131. 
Euphagia,  78. 
Evaporation  in  preservation  of  food.     See 

Dehydration. 
Excretion  of  fat,  in  stools,  percentage  of, 

105. 
Excretory  products,  calorific  value  of,  254. 
Rubner's    table    showing    losses    and 
available  energy,  255. 


P 


Farinaceous    foods,   preparation   of.      See 

Recipes. 
Farina  dumplings,  preparation  of,  610. 
Fasting,  as  ancient  religious  rite,  112. 
as  cure  for  disease,  113,  114. 
effect  of,  on  metabolism,  117,  298. 
forced,  ravenous  hunger  result  of,  113. 
long-continued,  115. 
metabolic  carbon   and  nitrogen  balance 

during,  298. 
no-breakfast  plan,  113. 
in  religion,  112,  117. 
Fasting  experiments,  116. 

metabolic,   118. 
Fat,  in  breast  milk,  478. 
in  cow's  milk,  493. 
excretion    of,    in    stools,   percentage   of, 

105. 
percentage  of,  in  foods,  339. 
perversion  of  appetite  for  special  or  pe- 
culiar kinds  of,  119. 
versus  carbohydrates  as  protein  sparers, 
302. 
Fat    and     carbohydrate,     Kayser's     table 
showing    nitrogen    balance    when 
feeding  isodvnamic  quantities  of, 
303. 
sparing  power  of,  in  calorimetric  experi- 
ments   (Atwater),   304. 
Fat  and  vegetarian  diet,  Wait's,  528. 
Fat  consumption  in  United  States,  771. 
Fat-free  diet,  338. 


Fatless  milk,  desiccation  of,  15. 
Fatigue  poisons,  due  to  meat  eating,  207. 
Fats,  action  on,  of  heat,  52. 

deficiency  of,  in  breast  milk,  487. 
Feces,  nitrogen  in,  323. 
Feeding,   caloric  method   of.     See  Caloric 
Method  of  Feeding. 
of  infants.    See  Infant  Feeding. 
Ferment,  diastatic,  in  milk.  497.     * 
Fermentation  of  milk,  analysis  of  changes 

occurring  in,  568. 
Ferments,  in  breast  milk,  479. 
Ferratin,  355. 
Fish,  cooking  of,  66. 
history  of,  50. 
dried,  20. 

preparation  of.     See  Recipes,  fish, 
preservation  of,  by  chemical  agents,  7. 
by  drying,  20. 
by  freezing,  3. 
by  salting,  3. 
by  smoking,  2. 
Fish  soup,  preparation  of,  606. 
Fisher's  comparative  endurance  tests,  176. 
Fisher's  experiments   in  effect  of  diet  on 

endurance,  174. 
Fisher's  test  diet  and  endurance,  175. 
Fletcherism.     See  Bradyphagia. 
Folin's  views  on  protein  diet,  187. 
Food,  decomposition  of,  causes  of,  1. 

effects  of  work  and,  on  respiration,  293. 
and  emotions,  79. 
purin,  effect  of,  on  uric  acid,  334. 
purin  bodies  in,  333. 

quantity  of,  334. 
as  a  source  of  heat  and  growth.     See 

Caloric  Method  of  Feeding, 
substitutes  for,  108. 
weight  of  different  classes  of,  purchased 

per  man  per  day,  375. 
and  work,  79. 
Food  concentration,  basis  of,  70. 

composition  of  components  of  ration  of 

United  States  soldier,  72. 
composition     of     emergency     ration    of 

German  soldier,  72. 
concentrated   proteins,   70. 
condensed  foods,  70. 
desiccated  eggs,  71. 
desiccated  milk,  71. 
desiccated  vegetables,  70. 
desiccation,  70. 
dried  meat,  71. 
dried  vegetables,  70. 
Food  economics  in  war,  739. 

food  situations  in  countries  at  war,  740. 
summary  of,  773. 

use  of  certain  foodstuffs   in   war.     See 
Foodstuffs,  use  of,  in  war. 
Food  economy,  dehydration  as  factor  in,  10. 

necessity  for,  10. 
Food  material,  amount  required,  129. 

dependent   on    idiosyncrasy   and    cus- 
tom, 137. 
dependent  on  individual  capacity,  138. 


INDEX 


783 


Food  material,  amount  required,  in  oarlv 
life,  137. 
influence  of  work  on,  184. 
reserve  supply  of,  desirable,  120. 
Food  preservation,  basis  of,  1. 
methods  of.  1. 

canning,  or  exclusion  of  air,  6. 
classification  of,   2. 
cold  storage  or  refrigeration,  3. 
dehydration.     See  Dehydration, 
drying,  2. 
freezing,  3, 
salting,  3. 
smoking,  2. 
sterilization.  6. 

treatment    with    antiseptic    chemical 
agents.  7. 
Food  requirement,   12. 

adult,  per  kilo,  table  of,  365. 
dependent  on   idiosyncrasy  and  custom, 

137. 
dependent  on  individual  capacity,  138. 
in  early  life,  137. 
examples    of    food    actually    consumed, 

270. 
factors  governing,  265. 
age,  266. 

amount  of  heat  lost  by  body,  265. 
choice  of  food,  269. 
intensity  of  muscular  activity,  271. 
kind  of"  work,  184,  268. 
sex,  266. 

influence   of   internal    secretions    of 
Moman.  268. 
weight  of  body.  266. 
necessary  for  healthy  individual,  362. 
relation  of  height  to  weight.  363. 
storage  of  food  ingested  above,  366. 
Foods,    in    which    acid-forming    elements 
predominate,  357. 
in  which  base-forming  elements  predomi- 
nate, 358. 
calcium  content  of.  350,  351. 
calcium  oxid   in,   approximate  amoimts 

of,  353. 
canned,  in  tropical  climates,  400. 
Foods,  chemical  analysis  of,  257. 

choice  of,  as  factor  in  food  requirement, 

269. 
constructive  and  fuel,  251. 
consumption  of.  actual,  table  of,  270. 
increased  metabolism  following,  297. 
by  marching  soldiers  per  day,  382. 
containing  cellulose,   340. 
containing  potassium  chlorid,  348. 
c  intaiiiing    vitamines,    and    their    anti- 
neuritic  and  antiscorbutic  quali- 
ties, 228. 
butter   fat,  228. 
rice,  228. 
fat  in,  percentage  of.  339. 
fuel  and  constructive.  251. 
fiH'l   values  of,  calculations  of,  257. 
table  of.  258-263. 


Foods,  fuel  values  of,  unit  and  method  of 
measurement  of,  246. 
included  in  training  diets,  553. 
ingested,  caloric  values  of,  250. 
inorganic    constituents    of,    importance 

of,  357. 
iron  salts  contained  in,  355. 
magnesium  salts  in,  351. 

approximate  amounts  of,  353. 
palatable    preparation   of,   general    con- 
sideration, 577. 
phosphorus  content  of,  354. 

relation  of  vitamines  to,  233. 
preparation  of.     See  Recipes, 
reservation  of,  102. 
sodium  chlorid  in,  percentage  of,  346. 
sulphur  salts  in,  356. 
transmutability  of,  carbohydrates,  101. 
hydrocarbons,  100,  101. 
proteins,  101,  102, 
salines,  99. 
used  in  the  army,  dehydration  of,  37. 
used  in  the  army  and  navy.     See  Ra- 
tions. 

vitamine   content  of,   226. 

physiological  estimation  of,  232. 
Food  situation,  in  countries  at  war,  Ger- 
many, 740. 

agricultural  classes,  746. 

caloric  needs,  746. 

consumption  of  food  units,  1912- 
1913,  745. 

dietary  of  industrial  classes,  747. 

drying  process,  743. 

fat  a  prominent  factor,  744. 

feeding  of  military  prisoners,  751. 

finding  new  fodder,  742. 

liberal  rations  for  women  engaged 
in  manual  work  in  open  air,  744. 

peace-time  needs,  746. 

population  of,  and  caloric  needs  for, 
745. 

protein  nee<ls  in  ounces,  746. 

use  of  leaves,  742. 
Great   Britain,   adult  rations   in,   per 
head  per  week,   755. 

caloric  needs,  749. 

diet  of  munition  workers,  753. 

dietaries  for  three  middle-class 
families,  sixteen  persons  in  Eng- 
land before  voluntary  restriction, 
753. 

dietary  requirements,   747,  749. 

during  first  year  of  war,  749. 

during  year  'l916,    748. 

first  definite  steps  to  control  of 
supply,  747. 

importations  of  food  supplies  before 
the  war,  747. 

particulars  of  army  rations,  748. 

protein  requirements,  749. 

totil  quantities  of  foodstuffs  avail- 
able during  1909,   1913,  748. 


7»4 


INDEX 


Food  situation,  in  countries  at  war,  Great 
Britain,    unrestricted    diet    of    a 
sedentary   worker,   756-758. 
voluntary  rationing  scheme  in,  754. 
Ruhleben  diets  compared  with  stand- 
ard dietaries,  751. 
sugar  situation,  751. 
in  United  States,  causes  of  food  short- 
age, 768. 
cereal  grains,  769. 

concentrated   nature   of  our   food   ex- 
ports,   770. 
economic  viewpoint,  769. 
fat  consumption,  771. 
propositions    for     food    conservation, 

772. 
protein   consumption.   771. 
sugar  consumption,  771. 
use  of  grains  for  manufacture  of  al- 
cohol, 772. 
wheat  production,  768. 
Foodstuffs,  digestibility  of.     See  Digesti- 
bility of  Foodstuffs, 
staple,  percentage  of  utilization  of,  104. 
use  of,  in  war,  alcohol,  766. 
bread,  759. 
cereals,   749. 
corn,  763. 

extraction  from  total  grain,  760. 
oatmeal,  762. 
milk,    764. 
potatoes,  764. 

requiring  mastication,  761. 
sugar,  765 
utilization   of,   Avith  and   without   alco- 
hol, 308 
Food  values,  with  cost  per  1,000  calories, 
273. 
of  fruits,  comparison  of  fresh  and  dried, 

28. 
physiological,  255. 
Food  waste,   from   economical  standpoint, 
103. 
fats,  105. 
nutrient,     percentage    of,     in    ordinary 

mixed  diet,  106. 
physiological,   104. 
France,  armv  rations  of,  702. 

daily,  716. 
Freezing  of  food,  as  agency  of  preserva- 
tion, 3. 
Fruit,  in  diet  of  tropical  climates,  389. 
digestibility  of,  108. 

dried,  analysis  and  caloric  value  of,  per 

pound,  20. 

comparison    of    food    value    of    fresh 

and,  28. 

drying  of.     See  Dehydration  of  Fruits. 

fresh,  comparison  of  food  value  of  dried 

and,  28. 
necessity  of,  in  diet.  527. 
preservation  of,  by  dehydration.  9.    See 
also  Dehydration  of  Fruits, 
by  drying,  2. 


Fruit,  preservation  of,  by  sugar,  7. 

waste  of,  in  America,  10. 
Fruit  cure,  545. 
Fruit  diet,  apple-fasts,  545. 

in  disease,  544. 
-  experiments    with    various    fruits,    542 
543. 
grape  cure,  546. 
Jaffa's  observations  on  fruitarians,  543, 

544. 
Jaffa's  vegetarian  dietary,  542, 
lemon  cure,  546. 
low  in  protein,  541. 
low  in  protein,  fat  and  sometimes  caloric 

value,  541. 
nitrogen    equilibrium    maintainable    on, 

540. 
records  of  three  subjects  subsisting  on, 

Fruits,  comparison  of  food  value  of,  fresh 
and  dried,  28. 
cooked,    preparation    of.      See    Recipes, 

fruits, 
dried,    comparative    cost    of    total    nu- 
trients   and   fuel    value   of    some 
fresh  and.  31. 
economic   advantages  of,   30. 
fresh,    comparative  "cost    of    total    nu- 
trients   and    fuel    value    of    some 
dried  and,  31. 
Frying  of  fish,  66. 

of  meat,  definition  of  process,  58. 
mediums  suitable  for,  59. 
procedure  for,  59. 
temperature  of  fats  in,  59. 
Fuel  foods,  251. 

Fuel  values  of  food,  calculation  of,  chem- 
ical analyses  of  foods,  257. 
comparative    equivalents     in    metric, 
avoirdupois      and      apothecaries' 
weights  and  measures,  257. 
heat  produced  and  substances  burned 
in  calorimeter  distinguished  from 
heat  available  when  used  in  body, 
263. 
represented    bv    a    particular    menu, 

263. 
table  of  values  of  ordinary  foods  pre- 
pared to  serve,  258-263. 
imit    and    method    of    measurement    of, 
246. 

G 

Game  flavor,  cause  of,  63. 
Gastric  peristalsis,  inhibition  of,  by  sen- 
sory stimuli,  81. 
Gelatin,  as  a  protein  sparer,  305. 
Germanv,  armv  rations  of,  700. 
daily.  716!^ 
food  situation  in,  740. 
Gluttons,   differentiated   from  epicures   or 
gourmets,  131. 
from  large  eaters,  132. 
of  history,  132,  133,  1.34. 


INDEX 


785 


Gluttony,  132. 

chronic.  1.31. 
Gourmand,   132. 
Gourmandizing,  chronic,  131. 
Gourmets,  131. 

Gouty  diathesis,  in  children,  diet  for,  413. 
Grape  cure,  546. 
Great  Britain,  army  rations  of,  713. 

food  situation  in,  747. 
Gustation,  seat  of.  76. 

Gustative    bulbs,    veritable    savors    recog- 
nizable through,  77. 
Gustative  sense,  76. 


H 


Health,  influence  of  diet  on,  368. 
and  vegetable  diet,  52.5. 

Heat,  destructive  action  of,  on  vitamines. 
222. 

Heat  of  body,  loss  of,  amount  of,  265. 
regulation  of,  276. 
production  of,  during  rest,  279. 

Heat  energy,  liberated  by  oxidation  of  al- 
cohol, 406. 

Heat  production  in  twenty-four  hours  and 
gaseous  exchange  per  minute, 
during  absolute  muscular  rest  in 
fasting  condition,  280. 

Height  and   weight,  comparative,  of  chil- 
dren. 412. 
relation  of,  363. 
at  varying  ages,  standard,  table  of,  364. 

Hepatin,  355. 

Home  modification  of  cow's  milk,  506, 
512. 

Hominy  mush,  preparation  of,  609. 

Human  economy,  foods  required  by,  362. 

Hutchinson's  views  on  protein  diet,  187. 

Hvdrocarbons,  transmutabilitv  of,  100, 
101. 

Hydrolytic  cleavage,  preceding  every 
metabolic  transformation  of  pro- 
tein, 209. 

Hyperorexia,  120. 

Hypozanthin,  formation  of,  332. 


Ice   cream,   making  of.     See  Recipes,   ice 

cream. 
Idiosyncrasies,  personal,  in  eating,  89. 
Inanition,  causes  of.  111. 

death  from,  in  relation  to  body  weight, 

147. 
definition  and  symptoms  of.  111. 
Indians,  diet  of,  393. 

Infant   feeding,   artificial,    addition   of   al- 
kalines,  to   prevent  clotting,  494. 
analysis  of  whole  milk  varying  cream 
percentages    skimmed    and    sepa- 
rated milks,  513. 


Infant  feeding,  artificial,  buttermilk,  500, 
certified  milk,   489. 
Cheadle's  principles  of,  506. 
clinical  application  of,  509. 
condensed  milk,  499. 
difficulty  of  digestion  of  cow's   mi  Ik, 
511. 

failure   to    assimilate   salts   of   cow's 

milk,  496. 
and  good  air,  51 1. 
home   modification    or    adaptation    of 

milk,  506,  512. 
importance  of  mineral  salts,  497. 
importance  of  sugar,  495. 
importance  of  water,  497. 
important  rules  to  be  followed  in,  514, 

515. 

summary  of,  515. 
making  all  food  formulae  from  three 

ingredients,  514. 
management  of  casein  of  cow's  milk, 

512. 

necessary  elements,  511. 
overfeeding,  510. 
pasteurized  milk,  503. 
peptonized  milk,  501. 
proper  intervals   for  infants  of  vari- 
ous ages,  510. 
proprietary  or  patent  foods,  504. 

percentages,  508. 
quiet  in,  511. 

selection  of  cow's  milk  for,  489. 
sterilized  milk,  502. 
success  in,  510. 
sugars  in,  512. 

supplementary    articles    of    diet    be- 
tween  sixth   and   twelfth  month, 
514. 
breast    feeding,    471.      See   also    Breast 

Feeding, 
mixed,  488. 
Infants'    milk,    desiccated,    reconstruction 

of,  15. 
Insalivation,  in  process  of  digestion,  85. 
Intestinal  canal,  hygiene  of,  469. 
Intestinal     stasis,    chronic,    constant    ab- 
sorption of  poisonous  elements  in, 
459. 
diet  in,  464. 
diseases  due  to,  460. 
acidosis.  463. 

cutaneous  lesions,  463,  466. 
acne,  467. 

itching  dermatoses,  468. 
of  internal    secretions.   462. 
rheumatoid  arthritis,  460. 
ulcer  of  stomach  and  duodenum,  461. 
due  to  meciianical  obstruction.  458. 
maladies    without   satisfactory    etiology 

traceable  to.  459. 
treatment  of,  l)y  diet,  464,  465. 
by  manipulation,  464. 
by  surgery,   465,  466. 


786 


INDEX 


Intestinal    toxemia,    due    to    overeating, 

135. 
Intestines,  construction  of  abdominal  vis- 
cera   with    especial    reference    to 
drainage,  455. 
faulty  position  of  abdominal  viscera  due 
to  refinements  of  civilization,  456. 
hygiene  of,  and  effort  to  overcome  con- 
stipation, 457. 
general  considerations,  455. 
intestinal  canal,  469. 
intestinal  stasis,  chronic,  458. 
Invalid  broths,  599. 
Iron,  inorganic,  given  as  drug,  356. 
Iron  salts,  compounds  of,  355. 
contained  in  body,  355. 
contained  in  foods,  355. 
excretion  of,  355. 
Italy,  army  ration  of,  daily,  717. 
Itching  dermatoses,  treatment  of,  468. 


Jaffa's  vegetarian  dietary,  542. 
Japan,  armv  rations  of,  701. 

daily,  717. 
Jellies,  making  of.     See  Recipes,  jellies. 
Julienne  soup,  602. 

Just-Hatmaker   process    of   desiccation   of 
milk,  13. 


Kayser's  table  showing  nitrogen  balance 
when  feeding  isodynamic  quan- 
tities of  carbohydrate  and  fat, 
303. 

Kosevi's  maintenance  ration  for  the  aged, 
443. 


Labor,  diet  after,  429. 
Laborers,  dietary  of,  376. 
Lactalbumen,  in  cow's  milk,  493. 
Lactation,  daily  bowel  movement  during, 
482. 
diet  during,  429,  481. 

day's    ration,   calculated  by  Gautier, 

430. 
in   regard   to   quantity   of  mammary 

secretion.   431. 
rules  formulated  by  Rotch,  431. 
influence  of  diet  and  exercise  on,  431. 
period  of,  429. 
Lactic  acid,  in  souring  of  milk,  569. 
Lactic  acid  therapy,  569. 
Lacto-vegetarian  diet,  521. 

an  impossibility,  according  to  Caultey, 
523. 
Lactose,  in  breast  milk,  478. 
Langworthy's   dietary   standard   for    aged 

and  infirm,  443. 
Lecturers,  diet  for,  560. 


Legumes,   composition    and    fuel   value   of 
fresh  and  dried  42. 

dehydrated,  42. 
Lemon  cure,  546. 
Lentil  soup,  preparation  of,  604. 
Lipoids,  bio-electric  potentiality  of,  221. 

in  metabolism,  220. 

nitrogenous  importance  of,  219. 

substances  comprised  under,  220. 


M 


Magnesium  salts,  35L 
in  body,  352. 
in  food,  351. 

approximate  amount  of,  353. 
Malacia,  119,  120. 

Malnutrition,     chronic,     consumption     of 
energy  in,  160. 
Weir  Mitchell  diet  in  treatment  of,  549. 
Malted  milk,  in  infant  feeding,  505. 
Mastication,  act  of,  83. 

foods    requiring,    and   greater   nutritive 

value  of,  761. 
of  meat,  87. 

moderate,  necessity  for,  83. 
prolonged,    overdoing    of.      See    Brady- 

phagia. 
rapidity  of,  86, 
Matzoon  cure,  566. 

Maurel's  maintenance  rations  for  old  peo- 
ple, 443. 
Meals,  composition  of,  366. 
distribution  of,  366. 
drinking  of  water  with,  88. 
order  and  frequency  of,  in  diseased  con- 
ditions, 90. 
in  normal  health,  90. 
for    persons    engaged    in    commercial 

life,  91. 
for  persons  engaged  in  manual  labor, 

90. 
for  persons  engaged  in  night  work,  91. 
for    persons   engaged   in   professional 

vocations,  91. 
for  persons  engaged  in  skilled  labor, 

91. 
for  persons  leading  life  of  leisure,  91. 
regularity  of,  92. 
relation  of  medication  to,  96. 
Meat,  baking  of,  60.  ( 

boiling  of,  55. 
braising  of,  64. 
broiling  of,  63. 
comparative     composition     before     and 

after  cooking  of,  65. 
comparative    composition   of   water-free 
substance   of   meats,    before    and 
after  cooking,  66. 
concentration  of,  by   drying,   71. 
consumption  of,  in  America,  206. 
in  different  countries,  367. 
in  old  age,  451. 
in  tropical  climates,  395. 


INDEX 


787 


Meat,  cooking  of,  history  of,  50. 
Hee  also  Cooking,  of  Meat, 
digestion  of,  and  bolting  of,  88. 

and  mastication,  87. 
eating  of,  direction  of  allowance  of,  206. 
and  fatigue  poisons,  "207. 
restriction  of,  206. 
frying  of,  58. 
grilling  of,  63. 
mastication  of,  87. 

effect  of  bolting,  88. 
need   of,    felt  by   those  accustomed   to, 

308. 
overfeeding  on,  ailments  and  disorders 

due  to,  207. 
powdered,  20. 

disadvantages  of,  20. 
Italian  metliod  for  making  of,  20. 
preparation  of.     See  Recipes,  meats, 
preservation  of,  by  antiseptic  chemical 
agents,  7. 
by  canning,  0. 
by  cold  storage,  3. 
by  dehydration.     See  Dehydration  of 

Meat. 
by  drying,  71.     See  also  Dehydration 

of  Meat. 
by  freezing,  3. 
by  smoking,  2. 
by  sterilization,  6. 
roasting  of,  61. 
as  a  source  of  nitrogen,  174. 
steaming  of,  65. 
stewing  of,  57. 

tropical  disorders  due  to  eating  of,  179. 
Meat  diet,  amount  necessary  to  supply  re- 
quisite nutriment,  534. 
effects  of,  534. 
exclusive,  532. 
metabolism  with,  535. 
peoples  subsisting  on,  533. 
and  physical  power,  533. 
Salisbury  diet.  536. 

modified,  537. 
in  treatment  of  dyspepsia,  535. 
of  gout,  535. 
of  obesity,  535. 
of  tuberculosis,  534. 
zymotherapy,  538. 
Meat  extract,  iced,  preparation  of,  597. 
Meat  juices,  preparation  of,  595. 
Meat  soups,  preparation  of.    See  Recipes, 

Soups. 
Meat  supply,  of  French  army,  711. 
Mechanics,  dietary  of,  376. 
Medication,  relation  of,  to  meals,  96. 
Menopause,   derangement   of  nervous   sys- 
tem during,  432. 
diet  during,  432. 
diseases  developing  at,  433. 
period  of.  432. 
Menstruation,  diet  during,  425. 

disturbances    accompanying,    and    diet, 
425. 


Mental  powers,  effects  on,  of  overeating, 
1.35. 
of  underfeeding,   149. 

Metabolic    carbon    and    nitrogen    balance 
during  fasting,  298. 

Metabolism,   chemical   changes   of,   classi- 
fied, 286. 

constructive,  or  anabolism,  286. 
definition  of  term,  286. 
dependence  of  life  on,  287. 
effect  of  fasting  on,  117. 

experiments  in,  118. 
energy,  calculation  of,  from  carbon  and 
nitrogen    balance,    Atwater's    ex- 
periment, 296. 
factors  affecting,  acid-forming  and  base- 
forming  elements,  314. 
alcohol  as  a  protein  sparer,  306. 
calorimetric  method  of  studying,  29.'j. 
oarboliydrates  as  protein  sparers,  300. 
consumption  of  food,  297. 
fasting,  298. 
fat   versus    carbohydrates   as   protein 

sparers,  302. 
gelatin  as  protein  sparer,  305. 
metabolism    of    mineral     substances, 
311. 

metabolism  of  water,  308. 
nitrogenous  diet,  299. 
functions  of  different  organs  and  tissues 
in,  285, 

general  considerations  on,  285. 
lipoids  in,  220. 
with  meat  diet,  535. 
mineral,  311. 

acid-forming    and    base-forming    ele- 
ments of  diet,  357. 
calcium  diets,  low  and  high,  349. 
in  disease,  341. 

electrolytic   properties  of  salts,  343. 
importance  of,  in  processes  of  nutri- 
tion, 358. 
iron  salts,  355. 
magnesium  salts,  351. 
minerals    in    typical    dietaries,    daily 

quantities  per  man,  342. 
percentage  of  ash   in  bones,  muscles 

and  various  organs,  312. 
phosphorus,  352. 
potassium  chlorid,  348. 
salt-free  diet,  345. 
sodium  chlorid,  344. 
sulphur  salts,  356. 

and  variations  in  amount  of  salt  in- 
gested, 346. 
nitrogen,  in  old  age,  444. 
nitrogen  balance,  Neumann's  dietary  ex- 
periment, 310. 
of   overfeeding,    excess   of  proteins   and 

carbohydrates,  138. 
"oxidation  water"  resulting  from  com- 
bustion of  hydrogen  in  the  food, 
309. 


788 


INDEX 


Metabolism,  processes  of,  series  of,  287. 
various,  285. 
protein,  327. 
ammonia,  329. 
carbohydrate-free  diet,  338. 
catabolism  of  proteins,  169. 
cellulose  diet,  339. 
creatinin,  329. 
deaminization   of   proteins   in   amino- 

acids,   169. 
end  products  of,  on  both  high  and  low 

protein  diet,  328. 
fat-free  diet,  338. 
purin  bodies,  329. 
urea,  327. 
uric  acid,  329. 

retrograde,  or  catabolism,  287. 
salt,  in  disease,  341. 
of  starvation,  acute,  protein,  160. 

pathologj-  of,  158. 
of  underfeeding,  acute,  protein,  160. 
in  the  blood,  162. 
pathologj'  of,  158. 
protein,  153. 
secretion  of  bile,  162. 
Siven's  table  showing  gradual  rise  in 
protein    intake    but   with    a   con- 
stant and  sufficient  energy  intake, 
159. 
in  the  urine,   162. 
vitamine  role  in,  224,  229. 
of  water,  308. 
Metabolism  experiments,  balance  of  income 
and  outgo,  288. 
effects  of  food  and  work  on  respiration, 

293. 
exchange    of    material    with    standard 

diets,  288. 
respiratory  quotient,  292. 
summary     of,     income     and     outgo     of 
energy:    calories,   291. 
income  and  outgo  of  nitrogen  and  car- 
bon, 290,  296. 
Mexicans,  dietary  of,  383,  384. 
Microorganisms   in  breast  milk,  474. 
Military  training  camps  for  boys,  rations 
for.     See  Rations,  boys'  military 
training  camns. 
Milk,  analysis  of  changes  occurring  in  fer- 
mentation of,  568. 
boiling  of,  value  of,  493. 
breast.     See  Breast  Milk. 
certified,  489. 

clots  of.  in  cow's  and  human,  493. 
prevention  of,  by  addition  of  alkali, 
494. 
coagulation  of,  477. 
comparative    analysis    of    human     and 

cow's,  490. 
comparative   composition   of,   from   dif- 
ferent animals,  490. 
composition  of,  carbohydrates,  494. 
chemical,  491. 
diastatic  ferment,  497. 


Milk,  composition  of,  fat,  493. 

inorganic  contents,  495. 

lack  of  uniformity,  492. 

proteins.  493. 

salts,  496. 

vitamines,  498. 
condensed,  in  infant  feeding,  499. 
description  of,  492. 
desiccated,  71. 

desiccation  of.     See  Desiccation  of  Milk, 
in  diet  in  tropical  climates,  304. 
fatless,  desiccation  of,  15. 
home  modification  or  adaptation  of,  in 

infant  feeding,  506,  512. 
for  infants,  reconstruction  of  desiccated 

milk  into,   15. 
malted,  in  infant  feeding.  505. 
pasteurized,  in  infant  feeding,  503. 
sour,  composition  of,  percentages,  566. 
souring  of,  by  lactic  acid.  560. 
sterilized,  in  infant  feeding,  502. 
use  of,  in  war,  764. 

varying    composition    of    morning    and 
evening,  492. 
Milk  cure,  569. 

application  of,  570. 
buttermilk  cure,  566. 
indications  for,  571. 
kumiss  cure,  564. 
matzoon,  566. 

quantities  administered,  571. 
skim  milk  cure,  572. 
sour  milk  cure,  567. 
whey  cure,  573. 
Mineral  metabolism,   311. 

acid-forming  and  base-forming  elements 

of  diet,  357. 
calcium  diets,  low  and  high,  349. 
in  disease,  341. 

electrolj'tic  properties  of  salts,  343. 
importance  of,  in  processes  of  nutrition, 
358. 

iron  salts,  355. 
magnesium  salts,  351. 
minerals  in  typical  dietaries,  dailj-  quan- 
tities per  man,  342. 
percentage  of  ash  in  bones,  muscles  and 

various  organs,  312. 
phosphorus,  352. 
potassium   chlorid,  348. 
salt-free  diet,  345. 
sodium  chlorid,  344. 
sulphur  salts,  356. 
Minerals  in  typical  dietaries,  daily  quan- 
tities per  man.  342. 
Mitchell,  Weir,  diet  in  treatment  of  neu- 
rasthenia  and   disorders  of  mal- 
nutrition  independent  of  organic 
disease.  549. 
Modification  or  adaptation  of  milk,  home, 

in  infant  feeding.  506,  512. 
Muscular   activity,   as   factor   in   food   re- 
quirement, 271. 
Glutton  broth,  preparation  of,  508. 


INDEX 


789 


N 


Neproos,  dietary  of,  382,  384. 
Nestle's  food.  50.t. 

Neumann's  dietary  experiment,  310. 
Xeurasthenia,  Weir  Mitchell  diet  in  treat- 
ment of,  549. 
full  dietary,  5.51. 

.synopsi.s  of  management  of  individual 
case,  550. 
Nitrogen,  in  diet,  321. 
in  feces,  328. 

income    and    outgo    of    carbon    and,    in 
metabolism  experiments,  290,  296. 
requirement  of,  for  maintenance,  181. 
value  of  meats  as  a  source  of,  174. 
Nitrogen      equilibrium,      Kayser's      table 
.showing,    wlien    feeding    isodyna- 
mie    (piantities    of    carbohvdrate 
and  fat,  303. 
maintenance  on  fruit  diet,  540. 
maintenance  of,  323. 
minimum    protein    necessary    to    main- 
tenance of,  153. 
Neumann's  dietary  experiment,  310. 
and  protein  diet,  Benedict  on,   189. 
Folin's  views  on,  187. 
Halliburton  on,  189. 
Meltzer  on,  189. 
protein      re(]uirement,      minimum,      for 

maintenance  of,  194. 
table  showing  effect  of  insufficient  diet 
with  gradual   increa.se  in  aliment 
until  establishment  of,  157. 
in  tropics,   322. 
Nitrogen-free  diet,  325. 
Nitrogen  increase  in  convalescents,  due  to 
overfeeding,     table     emphasizing, 
142. 
Nitrogen  nu>tabolism   in  old  age,  444. 
Nitrogenous  diet,  effect  of,  on  metabolism, 
299. 
increased,  effect  of,  on  kidneys,  191. 
Nitrogenous  importance  of  lipoids,  219. 
Nursing.     .SVp  Breast  Feeding. 
Nutrition,  disorders  of.  Weir  Mitchell  diet 
in  treatment  of,  549. 
function  of  carbohydrates  in,  .301. 
importance    of    mineral    metabolism    in 

processes  of,  358. 
importance  of  protein  in,  530. 
Nutritive   drink   for    delicate   women   and 

children.  599. 
Nuts,  cooking  of,  041. 
digestibility  of,  641. 
nutritive  value  of,  641. 


0 


Oatmeal,  use  of,  in  war,  762. 

with  beef  tea.  preparation  of,  594. 
Oatmeal  mush,  preparation  of,  009. 
Occupation,  and  diet,  371. 

and  digestion,  94. 

150 


Occupation,  protein  diet  and,  193. 
Oils,   use  of  in   preservation  of  food,  7. 
Old  age,  and  arteriosclerosis,  438. 
arteriosclerosis  as  sign  of,  434. 
cause  of,   434,   435. 
definition  of,  434. 

diet    in,     according    to    Campbell.     Dr. 
Harry,  440. 
according    to    Friedenwald    and    Ruh- 

riih,  441. 
alimentary  pastes:  food  value,  449. 
in  bronchitis,  452. 
caloric  value  of,  448. 
and  condition  of  teeth,  450. 
idiosyncrasy  a  factor,  441. 
Kosevi's   maintenance  ration.  443. 
Langworthy's  dietary  standard,  443. 
Maurel's  nuiintenance  rations,  443. 
meat  consumption.  451. 
nature  of,  439. 
quantity.  436,  439. 
r«'duction  of  fuel   value,  445. 
Raundby's  daily  dietary,  446. 

showing  distribution  of  meals,  447. 
suggestions  of  Yeo,  452. 
Voit's  dietary  standard,  442. 
diet  for  prevention  of,  434. 
eliminating  and  storage  powers  in,  437. 
exceptions    to    general    rules    regarding, 

435. 
means  of  preventing,  434. 
nitrogen   metabolism   in,   444. 
pathological  changes  incident  to,  438, 
Olives,  dried,  28. 
Onions,  dehydrated,  40. 
Osmozone,  62. 

Overeating,  in  the  aged,  137. 
in  children,    136. 
chronic,   130. 
in  early  life,   137. 
effects  of,  biliousness,  135. 
intestinal  toxemia,  135. 
on  mental  powers,  135. 
habitual,  136. 

individual  capacity  to  cope  with,  138. 
meaning  of,  127. 
men    conspicuous    for,    in    history,    132,. 

133,  1.34. 
moderate,    129. 
occasional,    129. 
tendency  to,  128. 
Overfeeding,  acute,  128. 
in  children.  136. 
chronic,   128. 
of  convalescents.   141. 
argument  against.  144. 
conclusions  on.  145. 
interchange   of  nitrogen   and   stoiu^f, 
I)rotein  and  fat  in,  table  showing 
approximate    values    nf,    absolute 
and    ])erc<'ntage.    143. 
nitrogen  increase  due  to,  table  empha- 
sizing,  142. 
dangers  of,   197. 


790 


INDEX 


Overfeeding,  definition  of,  138. 
of  infants,   510. 
of  meats,  ailments  and  disorders  due  to. 

207. 
metabolism   of,  excess  of   proteins   and 

carbohydrates,    138. 
prevalence  of,  128. 
in  youth  and  early  adult  life,  197. 
Overmastication.     See  Bradyphagia. 
"0-xidation    water,"    resulting   from    com- 
bustion of  hydrogen  in  the  food, 
309. 
Oyster  juice,  preparation  of,  598. 
Oyster  soup,  preparation  of,  608. 
Oyster  stew,  preparation  of,  607. 


"Palatability,"  use  of  term,  77. 
Parorexia,  119. 

Pasteurized  milk,  in  infant  feeding,  503. 
Patent  foods.     »S'ee  Proprietary  or  Patent 

Foods. 
Peaches,  dried,  24. 
Pellagra,  due  to  vitamioe  deficit,  232,  237. 

relation  of  spoiled  corn  to,  44. 
Peptonized  beverages  and  foods,  prepara- 
tion  of.      See   Recipes,   beverages 
and  foods. 
Peptonized  milk,  in  infant  feeding,  501. 
Persimmon,  dried,  28. 

Perversions  of  appetite.   See  Appetite,  per- 
versions of. 
Phosphorus,  importance  of,  352. 

as  building  material,  354. 
Phosphorus  content  of  foods,  354. 

relation  of  vitamines  to,  233. 
Pica,  119. 
Plavfair's  table  of  requirements  for  work, 

377. 
Poison,  protein,  168. 
Poisoning,  from  canned  goods,  6. 
Polydipsia,  121. 
Polyphagia,  121. 
Potassium  chlorid,  foods  containing,  348. 

importance  of,  348. 
Potato  flour,  35. 

Potato  soup,  preparation  of,  604. 
Potatoes,  dehydrated,  33. 
composition  of,  34. 
composition  and  fuel  value  of,  under 
various  methods  of  preparation, 
34. 
method  of  dehydration,  33. 
potato  flour,  35. 
sweet,  dehydration  of,  35. 
use  of,'  in  war,  764. 
white,  value  of,  213. 
Poultry,    preparation    of.      See    Recipes, 

poultry. 
Pregnancy,  albuminuria  and  dropsy  com- 
plicating, 426. 
diet  during,  425. 

longings   for    various   indigestible   arti- 
cles, 426. 


Prochownick's  diet  for  pregnancy,  428. 
Proprietary    or    patent    foods,    in    infant 
feeding,  504. 
in  infant  feeding,  list  of,  508. 
malted  milk,  505. 
Xestle's  food,  505. 
percentages,  508. 
Protein  consumption  in  United  States,  771. 
Protein  content,  character  of  diet  and,  212. 
Protein  deficiency,  caution  as  to,  196. 
Protein  diet,  efi"ect  of,  on  health  and  en- 
durance, high  protein  diet,  169. 
low  protein  diet,  171. 
on  strength  and  endurance,  192. 
end  products  of  protein  metabolism  on, 

328. 
high,  169,  325. 

versus  low,  185. 
low,  324. 

Baeltz's  investigations  among  the  Jap- 
anese,  176. 
Chittenden's    investigations,    171. 
efl"ect  of,  on  animals,  102. 
Fisher's  investigations,  174. 
high  versus,  185. 
and  nitrogen  equilibrium,  Benedict  on, 
189. 
Folin's  views  on,  187. 
Halliburton  on,  189. 
Meltzer  on,  189. 
and  occupation,  193. 
reduction  of,  necessary,  190. 
value  of  meats  as  a  source  of  nitrogen, 
174. 
Protein  digestion,  107. 

ill-effects  of  absorption  of  end-products 
of,  198. 
Protein  fractions,  chemical   formation  of, 

198. 
Protein  metabolism,  327. 
ammonia,  329. 
carbohydrate-free  diet,  338. 
cataboiism  of  proteins,  169. 
cellulose  diet,  339. 
creatinin,  329. 
deaminization    of    proteins    in    amino- 

acids,  169. 
end  products  of,  on  both  high  and  low 

protein  diet,  328. 
fat-free  diet,  338. 

governed  by  tissue  requirements,  299. 
purin  bodies,  329. 
revolution  in  conception  of,  167. 
of  starvation,  acute,  160. 
theories  of,  203. 
of  underfeeding,   153. 
urea,  327. 
uric  acid,  329. 

and   variations   in    amount  of  salt   in- 
gested, 346. 
Protein  molecule,  structure  of,  168. 
Protein  poison,  168. 

Protein-poor  foods,  percentages  of  protein 
in,  326. 


INDEX 


791 


Protein  requirement,  Chittenden  low  pro- 
ten  dietary,  253. 

determinations  of,  253. 

for  growing  boy,  690. 

minimum  to  maintain  nitrogen  equi- 
librium, 194. 

standard  for,  180. 
Proteins,  amino-acids  in,   194. 

animal  versus  vegetable,  528. 

building  up  of,  208. 

catabolism  of,  169. 

coagulation  of,  107. 
by  heat,  52. 

combustion  of,  adapted  to  intake  of,  300. 

concentrated,   70. 

in  cow's  milk,  493. 

deaminization   of,  in  amino-acids,   169. 

deficiency  in,  in  breast  milk,  487. 

differences  in  suitability  for  tissue  con- 
struction, 202. 

excess  of,  in  metabolism  of  overfeeding, 
138. 

form  of  absorption  of,  209. 

importance  of,  in  alimentation,  530. 

minimum,  necessary  to  maintain  nitro- 
gen equilibrium,   153. 

nature  of,  167. 

necessity  of,  to  blood  and  muscles,  205. 

percentages  of,  in  protein-poor  foods, 
326. 

physical  absorption  of,  differences  in 
suitability  for  tissue  construction, 
202. 

physical  properties  of,  201. 
relative  absorption,  202. 

qualitative  variations  in  amino-acids  of, 
200. 

quantitative  differences  of,   199. 

relative  absorption  of,  202. 

relative  values  of  meat  and  vegetables, 
204. 

surplus  of,  from  suitable  food  mate- 
rials. 203. 

of  the  tissues,  interchange  of,  209. 

transmutability  of,  101,  102. 

vegetable,   212. 

vegetable  versus  animal,  528. 
Protein  sensitization,  attention  given  the- 
ory of,  170. 

condition  similar  to,  produced  by  over- 
feeding  of    a   particular   protein, 
169. 
Protein  sparers,  alcoliol  as,  306. 

carbohydrates  as,  300. 

carbohydrates  and  fat  in  calorimetric 
experiments   (Atwater),  304. 

fat  versus  carbohydrates  as,  302. 

gelatin  as.  305. 
Protein  and  starch  equivalents,  in  cereals 
and  buckwheat?*,  table  of.  391. 

in  pulse,  in  diet  of  tropical  climates, 
tabh'  of,  392. 

Protein  starvation,  effects  of,  156. 


Protein    structure    and   properties,   chem- 
ical   formation    of    protein    frac- 
tions, 198. 
qualitative    variations    in    the    amino- 
acids  of  proteins,  200. 
quantitative  differences  of  proteins,  199. 
Protein  tissue,  chemical  decomposition  of, 

158. 
Prunes,  dried,  22. 

Ptomaine   poisoning,   from  canned  goods, 
6. 
due  to  "high"  or  slightly  tainted  game 
or  meat,  63. 
Puberty,  beginning  of  period  of,  418. 
diet  during.     See  Diet  during  Puberty, 
improvements  desirable  in  present  cur- 
riculum of  schools,  420. 
question  of  stimulants  in,  420. 
Puddings,    preparation    of.      See   Recipes, 

puddings. 
Puerperium,  diet  during,  428. 
Purin  bodies,  in  animal  and  vegetable  ni- 
trogenous bodies,  331. 
chemistry  of,  330. 
in  food,  333. 

quantity  of,  334. 
occurrence  in  body,  331. 
production   of,   in   presence   of   cellular 

processes,  332. 
in  protein  metabolism,  329. 
source  of,  329. 
Purin  compounds,  solubility  of,  330. 
excess  of,  335. 
low,  336. 
Purin  foods,  effect  of,  on  uric  acid,  334. 
Purin-free  diet,  336. 

dinners    suggested    by    Haig's    disciple, 

337. 
indications  for,  336. 
to  supply  albumin,  336. 
Purins,  bound,  332. 
endogenous,  331. 
exogenous,  331. 

excretion  of,  333. 
free,  332. 

R 

Raisins,  methods  of  preparing,  26. 
Ration,  definition  of,  666. 
emergency,  666. 
field,  666. 
Filipino,  666. 
garrison.  666. 
haversack,  666. 
supplementing  of,  666. 
travel,  666. 
Rations,  army,  663. 

for  boys'  military  training  camps,  684. 
dearth  of  statistical  material  on,  684. 
dietarv  for  one  week.  Fort  Terry,  New 
York,  686-690. 
showing   requisite   amoimts  of  ter- 
nary  food    elements   and    ftiel   or 
•      energy  value  in  calories,  092-697. 


792 


IJ^DEX 


Rations,  for  boys'  military  training  camps, 
importance  of  sutticient  vitamino 
principles,  691. 
protein   requirement.  690. 
for  boys'  private  boarding  school,  685. 
of  foreign  armies,   697. 

comparative,  Austrian,  715. 
English,  716. 
French,  716. 
German,  716. 
Italian,  717. 
Japanese,  717. 
Russian,  717. 
comparative  tables  of  eight  countries, 

698.  699. 
emergency  ration,  700. 
of  France,  702. 

amount   given   out   and   carried    at 

one  time,  708. 
authorized     extraordinary     supple- 
ments, 706. 
authorized  substitutive  equivalents, 

705. 
in  the  cavalry,  708. 
commutation  of,  in  times  of  peace, 

706. 
components    of    garrison    and    field 

rations,  702. 
composition  of,  704. 
dailv  allowance  for  additional  sup- 
plies,  706. 
meat  supply,  711. 
methods  of  cooking  in  the  trenches. 

703. 
normal,  707. 

in  peace  and  in  war,  703. 
reserve,  707. 
strong,  707. 
trains,  709. 
in  the  trenches,  706. 
of  Germanv,  700. 
of  Great  Britain,  713,  748. 

during  Boer  War,  723. 
of  Japan,  701. 
meat    allowance    as    compared    with 

that  of  U.  S.  army,  697. 
of  Russia.  701. 
systems  of  supply,  714. 
of  French  navy,  729. 
military,   conclusions   regarding  compo- 
sition  and    food   value   of    (Har- 
vard), 722. 
in  military  prison  camps,  718. 

menu    taken    from    Camp    Guterslohe 
for    one    week,    officers'    section, 
719. 
menu  taken  from  Camp  Munster  for 

one  week,  718. 
weekly    diet   sheet   typical    of   period 
prior  to  stringencv  in  foodstuffs, 
721. 
tvpical   of   period  of   stringency   in 
'  foodstuffs,   721. 
navA',   comparative   nutritive   energy   of 
American  and  foreign,  729.* 


Rations,   U.    S.    army,   additional   articles 
consumed,  665. 
allowance  and  consumption  per  man, 

665. 
company  dietaries,  675. 
company  dietary  at  a  southern  post, 
676. 
at  a  western  post,  675. 
component  parts  of,  681,  726,  727, 
concentrated  foods,  674. 
dehydration  of  foods,  37. 
emergency,  673. 
field  ration,  670. 
Filipino  ration,  672. 
garrison   ration,   component  and   sub- 
stitutive articles   and  quantities, 
667. 
Colonel  Harvard  on,  666,  668,  669. 
haversack  ration,  671. 
ordering  of,  664. 
past  and  present,  681. 

amount  and  kind  of  food,  682. 
cases  of  rheumatism   among  veter- 
ans, 683. 
during  the  Civil  War,  683. 
present  policy  of  improvement,  682. 
percentage  of  waste  in,  665. 
quantity    of    stores    required    for   one 
dav's  subsistence  of  150,000  men 
in 'field,  683. 
savings,  672. 
selection  of,  674. 
ten  days'  ration  uncooked  food  for  an 

average  daily  of  440.4  men,  664. 
travel  ration,  672. 
in  tropics,  676. 

tropical  dietaries,  676. 

average    nutrient    composition    of, 

680. 
tables  of,  678,  679. 
U.  S.  navy,  724. 

commissary   store,   establishment  and 

administration.   734. 
daily  and  weekly,  725.  ' 

extra  allowance,'  723,  728. 
general  mess,  bakers,  734. 
commissary,  732. 
commissary  stewards,  733. 
cooks,  733. 

organization     and     administration, 
730. 
preparation  of  food,  cooking,  737. 
galley,  737. 
ration,  736. 
study  and  arrangement  of,  from  point 
of  view  of  efficient  service,  728. 
Recipes,  beverages,  with  egg  and  alcohol, 
brandy  and  egg  mixture,  586. 
caudle,  587. 
egg  flip,  587. 
egg-nog,   585.   586.  587. 
egg-nog,  beef -tea,  587. 
egg  and  grape  juice,  587. 
milk  punch,  587. 
wine,  mulled,  588. 


INDEX 


793 


Recipes,  beverages,  with  egg  and  alcoliol, 
wine  whey,  588. 
nutritious,  albumin  water,  580,  581. 

albuminized  milk,  583. 

caudle.  581. 

cocoa,  582. 

coffee,  582. 

diluents,  various,  584. 

egg  and  buttermilk  mixture,  584. 

egg  broth.  581. 

egg  cordial,  581. 

egg  drink.  623. 

egg  flip,  585. 

grape  juice,  584. 

junket,    vanilla,    bitter    almond    or 
strawberrv,  584. 

kumiss,  582',  583. 

milk,  albuminized,  583. 
almond,  582. 

and  cinnamon  drink,  583. 
and  other  diluents.  584. 
and  Irish  moss,  583. 

milk  lemonade,  584. 

milk  mixture.   583. 

milk  porridge.  585. 

whey,  lemon,  582. 
plain,  apple  water,  578. 

barley  water,  580. 

currant  juice   (Fitch),  578. 

imperial  drink,  579. 

lemonades,  579. 

lime  water,  578. 

linseed  tea,  580. 

orangeade,   579. 

orgeat.  580. 

tamarind  water,  578. 

toast  water,  580. 
blancmange,  645. 

chocolate  or  cocoa,  G53. 
Irish-moss,  646. 
bouillon,  American,  601. 
l)oiling  of  meat  for,  56. 
bottle.   601. 
clam.  600. 

clam  I)ouillon  bisque.  600. 
general  procedure  for,  5(i. 
.      plain,  600. 
bread,  aleuronat  bread,  657. 

bran  muflin  for  constipation,  613. 

brown,  612. 

cornmeal  gems,  614. 

for  diabetics,  almond  biscuit,  660. 

bran,  657. 

bran  cakes,  Camplin's,  657. 

gum  gluten,  656. 

gum  gluten  muffins,  657. 

waffles,  658. 

Drexel  Institute  recipe,  612. 
graham.  613. 
nut  brown,  612. 
pulled.  613. 
toast.  614. 

cream.  615. 

milk.  614. 


Kecipes,  white  gems,  613. 
whole-wheat,  612. 
zwieback,  613. 
broths,  597. 
American,  601. 
beef,  598. 

with  egg  gruel,  618. 

and  grain.  599. 

with  poached  eggs,  599. 
boiling  of  meat  for,  56. 
chicken,  598. 
clam,  598. 
clam  juice,  598. 
egg,  581. 
in  general,  56. 
invalid,  .599. 
mutton,  598. 
mutton,  without  meat,  599. 

with  vegetables,  599. 
nutritive    drink    for    delicate    women 

and  children,  599. 
oyster  juice,  598. 
veal,  598. 

cakes,   for   diabetics,   aleuronat   and   al- 
mond, 659. 

almond  cakes,  658,  659. 

bran,  Camplin's,  657. 

cocoanut,  659,  661. 

cocoanut  and  almond,  661. 
cereal  foods,  flour  ball,  617. 
general,  615. 
gruels,  arrowroot,  619. 

barley,  619. 

with  beef  extract,  618. 

barley  meal.  619. 

barley  and  oatmeal  jelly,  618. 

cornmeal  gruel,  617,  618. 

cracker  gruel,  616,  617. 

egg,  618. 

farina.  616. 

flour.  616. 

flour,  or  thickened  milk,  619. 

flour  ball  gruel,  617. 

gluten.  618. 

imperial  granum,  616. 

meal   soup.  617. 

oatmeal,  616. 

oatmeal.  620. 

oatmeal   and  barley  jelly,  618. 

port  wine,  619. 

Racahout  des  Arabes.  617. 
length  of  time  for  cooking.  616. 
for  constipation,  bran  mulTms.  (il3. 
custards,  baked.  650. 
baked  or  cup,  648. 
chocolate,   649. 
cocoa  junket,  650. 
peach   meringue.  649. 
rennet,  or  plain  junket,  650. 
rules   for.  647. 
sauce.  648. 
savorv,  648. 
soft.  (547.  650. 
souffle.  (>49. 


794 


INDEX 


Recipes,   desserts.     See  Blancmange,  Cus-    | 
tards,  lee  Cream,  Jellies,  Junkets, 
Puddings, 
for  diabetic  foods,  aleuronat  bread,  657. 

aleuronat  pancakes,  660. 

aleuronat  and  almond  cakes,  659. 

aleuronat  and  suet  pudding,  660. 

almond  biscuit,  660. 

almond  cakes,  658,  659. 

almond  pudding,    662. 

bran  cakes,  Camplin's,  657. 

cocoanut  and  almond  cakes,  661. 

cocoanut  cakes,  659,  661. 

cocoanut  pancakes,  661. 

cocoanut  pudding,  662. 

gum  gluten  bread,  656. 

gum  gluten  muffins,  657. 

waffles,  658. 
dressings,  cream,  638. 

mayonnaise,  637. 
dumplings,  egg,  607. 

farina,  610,  611. 

potato,  611. 
for  dyspeptics,  jelly,  643. 
eggs,  cooking  and  digestibility  of,  62CL 

egg  drinks.   See  Beverages,  nutritious, 
and  Beverages,  egg  and  alcohol. 

egg  gruel,  618. 

hard-cooked,  620. 

omelet,  621. 

omelet  souffle,  621. 

poached,  623. 

with  cheese,  624. 

prairie  oyster,  622. 

rumbled,  623. 

snowball,  622. 

soft-cooked,  621. 
farinaceous  foods,  cornmeal  mush,  609. 

farina  dumplings.  610,  611. 

hominy  mush,  609. 

macaroni,  boiled,  610. 
and  rice,  610. 

oatmeal    mush    for    children    and    in- 
valids, 609. 

potato  dumplings,  611. 

rice,  boiled,  608. 

Italian   (with  cheese),  610. 
and  macaroni,  610. 
plain  boiled,  610. 
fish,  baked,  624. 
in  butter,  626. 

dietary  value  of,  624. 

frying  of,  66. 

oysters,  broiled,  627. 
panned,  627. 

sole  or  whiting,  steamed,  625. 

souffle,  627. 

steamed  sole  or  whiting,  625. 

stewec^  625. 
fruit  ice  creams.    See  Ice  Cream, 
fruits,  apples,  baked,  639. 

apricot  and  prune  sauce,  639. 

fig^  stewed,   640. 

orange,  640. 

peach  meringue,  649. 


Recipes,  fruits,  pineapple,  640. 
pineapple  cream,   652. 
prunes,  stewed,  640. 
gruels,  egg,  618. 

See  also  Cereal  Foods, 
ice  cream,  caramel,  056. 
chocolate,  655. 
junket,  655. 
peach,  655. 
strawberry,  655. 
vanilla,  656. 
jellies,  642. 

calf's  foot,  643. 

chicken,  642. 

coffee,  nutritious,  646. 

cream,  or  blancmange,  645. 

for  dyspeptics,  643. 

general    directions    for    dishes    made 

with  gelatin,  644. 
Irish-moss  blancmange,  646. 
lemon,  645. 
meat,  642. 

with  gelatin,  647. 
with  Irish  moss,  647. 
with  tapioca,  647. 
milk,  644,  646. 
orange,  645. 
veal-bone,  642. 
wine,  645. 

sweet,  from  gelatin,  645. 
junket  ice  cream,  655. 
junkets,  cocoa,  650. 

plain,  or  rennet  custard,  650. 
vanilla,  bitter  almond  or  strawberry, 
584. 
meat  juices,  595. 
beef  essence,  597. 

beef   juice    (Bartholow,    Cautley    and 
Ringer),  596. 
cold,  597. 
beef  teas,  593-595. 

meat  extract,  iced    (Ziemssen),  597. 
meat- juice   mince    (Watson),  596. 
Watson's  home-made,  595. 
meat  jellies.     See  Jellies, 
meat  soups.     See  Soups, 
meats,  baking  of,  60. 

beef.  Hamburger  steak,  632. 
beef  pulp,  631. 
beef  quenelles,  631. 
raw,  beefsteak,  .633. 

general  method  of  preparing,  632. 
juice,  633.. 

with  milk  and  sugar,  633. 
soup,  633. 

succus  carnis    (meat  juice),  633. 
boiling  of,  56. 
braising  of,  64. 
broiling  of.  63,  630. 
frying  of,  59. 

general  rules  for  preparing,  630. 
grilling  of,  63. 
pan-broiling  of,  631. 
roasting  of,  630. 
sweetbreads,  stewed,  632. 


INDEX 


795 


Recipes,  meats,  veal,  roast,  631. 
venison,  roast,  632. 
meringues,  peach,  649. 
musli.     See  P'arinaceous  Foods, 
nuts,  chestnut  puree,  641. 
cooking  of,  641. 
digestibility  of,  641. 
nutritive  value  of,  641. 
pancakes,  for  diabetics,  aleuronat,  660. 

cocoanut,   661. 
peptonized  and  predigested  foods,  588. 
cereals  partially  digested,  prepared  at 

table,  589. 
grape  juice  whey,  593. 
junket,  or  curds  and  whey,  592. 
cocoa,  592. 
coffee,  592. 
with  egg,  592. 
iodized,  593. 

milk,   partially  peptonized,  589. 

peptonized,  590. 
milk  gruel,  peptonized,  591. 
milk  jelly,  peptonized,  591. 
milk  lemonade,   peptonized,  591. 
milk  punch,  peptonized,  591. 
peptonized  beef,  588. 
peptonized  oysters,  589. 
whey,  593. 

grape  juice,  593. 
poultry,  broilers,   boiled,  629. 

stewed  or  potted,  629. 
capons,  629. 
chicken,  broiled,  628. 
chicken  puree,  638. 
chicken  salad,  628. 
flesh  of.  628. 
partridge,  stewed,  629. 
roast.  629. 
squabs,  boiled.  629. 
stewed  or  potted,  629. 

puddings,   aleuronat   and   suet,   for   dia- 
betics, 660. 
almond,  for  diabetics,  662. 
arrowroot,  651. 
bread,  651. 

and  butter,  baked,  654. 
plain,  653. 

chocolate  or  cocoa  blancmange,  653. 

cocoanut,  for  diabetics,  662. 

cornstarch,  652. 

pineapple  cream,  652. 

rice,  6.51. 

and  egg,  651. 
plain,  652. 

sponge,  654. 

tapioca  and  sago,  653. 
purees,  chicken,  638. 

endive,  639. 

lettuce,  638. 

red  cabbajre,  630. 
salads,  chicken,  628. 
sauces,  custard,  648. 

for  vegetables,  (535. 
soups,  egg  dumpling,  607. 


Recipes,  soups,  fish,  606. 
oyster  soup,  608. 
oyster  stew,  607. 
meat,  605. 

first   stock   for   clear   brown    soup, 

606. 
general  directions  for,  605. 
raw-beef,  633. 
sweetbread  soup,  607. 
vegetable,  601. 
brown,  605. 
Brunoise,  604. 
clear,  or  consomme,  603. 
consomme  and  egg,  604.  ^ 
cream-of-celery,  602. 
cream-of-potato,   602. 
cream-of-tomato,  601. 
Julienne,   602, 
lentil,  604. 
without  meat,  601. 
potato,  604. 
tapioca,  602. 
white,  603. 
toast,  614. 
cream,  615. 
milk,  614. 
vegetables,  asparagus,  635. 
carrots,  636. 
cauliflower,  636. 
cauliflower  a  I'lndienne,  636. 
dressings,  cream,  638. 

mayonnaise,  637. 
endive  puree,  639 
general  rules  for  cooking,  634. 
lettuce  puree,  638. 
oyster  plant,  635. 
peas,  green,  636. 
potatoes,  mashed,  636. 
red  cabbage  puree,  639. 
sauce  for,   635. 
spinach,  635. 
string  beans,  636. 

time-table  for  cooking,  in  water,  634. 
tomato  savory,  637. 
Reducing  dietary,  559. 
Refrigeration.     See  Cold  Storage. 
Reservation  of  foods,  102. 
Respiration,  effects  of  food  and  work  on, 

293. 
Respiratory  quotient  in  metabolism,  292. 

calculation  of,  294. 
Rheumatoid   arthritis,  due  to  chronic  in- 
testinal stasis,  460. 
Rice,  and  vitamines,  228. 
Richards*    ration    for    sedentary    occupa- 
tions, 424. 
Roasting    of    meat,    comparison    of,    with 
baking,  60. 
process  of,  61. 
temperature  for,  62. 
Rubner's  table  showing  losses  and   avail- 
able energy,  255. 
Rumination,  121. 
.  Russia,  army  rations  of,  701. 
daily,  717. 


796 


i:n^dex 


s 


Salines,  transmutability  of,  99. 
Salisbury  diet,  536. 

modified,  537. 
Salivary   digestion,  time   and  manner  of, 

85. 

Salsify,  dehydration  of,  37. 
Salt,  abuse  of,  347. 

action  of,  in  water,  in  boiling  of  meats 

and  fish,  57. 
craving  for,  relation  of  diet  to,  347. 
Salt-free  diet,  345. 
Salt  metabolism,  in  disease,  341. 
Salting  of  food,  as  agency  of  preservation, 

3. 
Salts,  calcium,  349. 
in  cow's  milk,  496. 
electrolytic  properties  of,  343. 
exchange    of,    in    bod}%    sodium    chlorid 

and  potassium  chlorid,  348. 
iron,  355. 
magnesium,  351. 
phosphorus,  352. 
potassium  chlorid,  348. 
sodium  chlorid,  344. 
sulphur,  356. 
Saundby's  daily  dietary  for  the  aged,  446. 

showing  distribution  of  meals,  447. 
School  children,  diet  of,  414,  416. 

and  hvgienic  condition  of  buildings  for, 

417. 
medical  inspection  of,  417. 
Scurvy,    due    to    deprivation    of    organic 
acids,  315. 
in  infants,   due  to  destruction  of  vita- 
mines  in  food,  498. 
relation,  of  diet  to,  358. 
Seasickness,  122. 

Secretions,   internal,  eflfect  on,  of  chronic 
intestinal  stasis.  462. 
of  woman,  as  influencing  food  require- 
ment, 268. 
Sedentary  occupations,  diet  in,  421. 
Senility,   premature,  433. 
Sense,  of  taste.  76. 

and  associated  senses,  77. 
Senses,  role  of,  in  pleasure  of  eating,  75. 
Sherman's  estimates  of  Atwater's  experi- 
ments  for  calculation  of  energy 
metabolism,  297. 
Singers,  diet  for,  560. 
Skim  milk  cure.  572. 
Sleep,  and  digestion,  93. 
Smoking  of  food,  process  of,  2. 
Sodium  chlorid,  consumption  of,  344. 
importance  of,  in  diet,  344. 
percentage  of,  in  foods,  346. 
retention  of,  in  tissues,  345. 
See  also  Salt. 
Sodium  equilibrium,  maintenance  of,  348. 
Soldiers,   marching,    energy    expended   by, 
382. 
food  consumed  by,  per  day,  382. 


Soldiers'  rations.     See  Rations. 

Soups,  value  of,  in  dietary,  605. 

Sour    milk,    composition    of,    percentages. 

Sour  milk  cure,  567. 

Souring  of  milk  by  lactic  acid,  569. 

Soy  bean  flour,  43. 

Soy  beans,  dehydration  of,  42. 

Starch  and  protein  equivalents,  in  cereals 
and  buckwheats  in  diet  of  trop- 
ical climates,  table  of,  391. 
in   pulse,   in   diet  of   tropical   climates, 
table  of,  392. 

Starches,  dextrinization  and  gelatinization 
of,  by  heat,  52. 

Starr's   table   of   dietetic   needs   in   child- 
hood, 410. 

Starvation,  account  of  miseries  of,  110. 
acute,  protein  metabolism  of,  160. 
death  from,  in  relation  to  body  weight, 

definition  and  process  of,  109. 

duration  of  life  under,  109,   147. 

metabolism  of,  pathology  of,  158. 

percentage  of  loss  of  body  weight  and  of 
loss  in  fat.  111. 

period  of  time  during  which  difi"erent 
individuals  can  subsist  without 
food,  factors  influencing,   109. 

sensations  during,   147. 
Stauf  process  of  desiccation  of  milk,  14. 
Steaming  of  meat,  65. 
Sterilized  milk,  advantages  of,  503. 

disadvantages  of,  503. 

in  infant  feeding,  among  the  poor,  502. 

process  of,  503. 
Sterilization  of  food,  as  means  of  preser- 
vation,  6. 
Stewing  of  meat,  difference  between  boil- 
ing and,  57. 

procedure  for,  58. 
Stimulants,  in  puberty,  420. 
Strength,  effect  of  protein  diet  on,  192. 
Substitutes  for  food,  108. 
Sugar,  action  on,  of  heat,  52. 

consumption  of,  in  United  States,  771. 

use  of,  in  preservation  of  food,  7. 
in  war,  765. 
Sulphur  salts.  356. 

in  foods,  356. 
Sun-drying  of  fruit,  21. 
Superalimentation,  acute,   128. 

in  children,  136. 

chronic,  128. 

prevalence  of,  129. 

See  also  Overfeeding. 
Sweets,  craving  for,  by  adolescents.  420. 

in  diet  of  tropical  climates,  398. 


Tachvphagia,  definition  of,  84. 
iireflfects  of,  84,  85. 


INDEX 


797 


Taste,  associated  senses,  77. 

use  of  term,  7(5. 
Teeth,  condition  of.  in  old  ajje,  450. 
Tellier  metiiod  of  dehydration  of  meat,  1!). 
Temperature  of  the  body,  heat  production 
during  rest,  279. 
in    sleep    calculated    for    twenty-four 
hours,  table  of,  277. 
regulation  of,  274. 
chemical,   275. 

gaseous  exchange  per  minute  and  heat 
production  in  twenty-four  hours, 
during  absolute  muscular  rest  in 
fasting  condition,  280. 
involuntary.  274. 
physical,  275. 
resume  of.  27!). 
surface  areas  of  skin  in,  276. 
regulation  of  heat  loss,  270. 
Thirst,  excessive,  or  polydipsia,  121. 
Thirst  quenchers,  5()2. 

Tissue  construction,  differences  in  suitabil- 
ity of  proteins  for,  202. 
Toast,  preparation  of.    See  Recipes. 
Toxemia,    intestinal,    due    to    overeating, 
135. 

Training,  general   principles  of,  552. 

length  of  time  necessary  for,  553. 
Training  camp,  boys'  military,  rations  for. 
See    Rations,    for    boys'   military 
training  camps. 
Training  diet,  basis  of,  552. 

dietary  studies  of  university  boat  crews, 
555. 

food  included  in,  553. 
general  diflference  between  food  of  ath- 
letes and  other  people,  557. 
necessity  and  object  of,  552. 
for  one  day   for   summer  races,   Oxford 

and  Cambridge.  556. 
for   one   day   for    winter    races,   Oxford 

and  ('ambridge,  557. 
summing  up   of  researches   and   experi- 
ments   of    Atwater    and    Bryant, 
557,  558. 
of  Yale  training  crew.  554. 
Transmutabilitv   of   foods,  carbohydrates, 
101. 
hydrocarbons,  100,   101. 
proteins.   101,  102. 
salines,  00. 
Tropical  climates,  alcohol  in,  401. 
beverages  in.  405. 

diet  in.     Sec  Diet  in  Tropical  Climates. 
Tropical  dietaries,  in  U.  S.  army,  670. 
Tropical  dieases,  due  to  meat  eating,  170. 
Tuberculosis,   meat   diet  in   treatment   of. 
534. 
treatment  of.  by  zymotherapy.  538. 
Tuberculous  children,  dietary  for.  413. 
Tubers,     starch-vielding,    dehj'dration     of. 

36. 
Tufnell's  diet  for  treatment  of  aortic  and 
other  aneurisms,  547. 


Turnips,  dehydration  of,  37. 
Typhoid  bacilli,  in  breast  milk,  474. 

U 

Ulcer  of  stomach  and  duodenum,  due  to 

chronic  intestinal   stasis,  401. 
Undereating,  caution  against.   197. 

coupled  with  indigestion,  190. 
Underfeeding,    acute,    protein    metabolism 
of,  100. 
caloric  deficit  of  gravest  import  in,  148. 
cause  and  prevalence  of,  145,  140. 
chronic  or  habitual,  140. 
conclusions  on,    ]()3. 
consumption  of  energy  in,   160. 
and  crime,  152.  153. 
maleficent  sequences  of,  148. 
crime,  152.  153. 
on  digestive  organs,  152. 
in  diminishing  resistance  to  cold  and 

exposure,  151. 
drinking.  152. 

increased  liability  to  disea.se,  151. 
mental     and     physical    deterioration, 

149. 
sapping  of  vital  forces,  151. 
in  women  and  children.   150. 
metabolism  of,  in  the  blood,  162. 
consumption  of  energy  in,  160. 
pathology  of.  158. 
protein  metabolism.  153. 
secretion  of  bile,  102. 
Siven's  table  showing  gradual  rise  in 
protein    intake   but   with    a   con- 
stant and  suflficient  energy  intake, 
159. 
in  the  urine.  102. 
prevalence  of,  in  all  countries,  1.50. 
in    laboring    population    of    England, 

149. 
in    laboring    population    of    Scotland, 
150. 
relationship  of,  to  disease,  151,  152. 
Undernutrition,  long-continued,   115. 

temporary.   115. 
Uric  acid,  effect  of  purin  foods  on,  334. 
origin  of,  335. 

in  protein  metabolism,  329. 
Urine,  effect  of  underfeeding  on,  162. 


Vegetable  diet,  disadvantages  of,  low  pro- 
tein  alimentation,   529. 

and  energy.  524. 

all   food  constituents  contained  in,  522. 

and  health.  525. 

history  of.  520. 

indications  for,  523. 

JafTa's  vegetarian  dietary,  542. 

lacto  vegetarian  diet.  521. 

opinions  of  Porphvre  and  Seneca  on, 
527. 


798 


INDEX 


Vegetable  diet,  opposed  to  scheme  of  diet, 
523. 
partial,  necessity  of,  527. 
and    question    of    fecudity   or    sterility, 

531. 
reasons  for,  520. 
summary  of  main  points  in  favor  of  and 

against,  531. 
vegetable  versus  animal  protein,  528. 
Wait's  vegetarian  and  fat  dietary,  528. 
Vegetable  foods,  cooking  of,  67.     See  also 
Cooking  of  Vegetables, 
digestibility  of,  107. 
Vegetable  flours,  use  of,  44. 
Vegetable  protein,  212. 
Vegetable  protein,  versus  animal  protein, 

528. 
Vegetable  soups.     See  Soups,  vegetable. 
Vegetables,  dehvdration  of,  11. 

See  also  Dehydration  of  Vegetables, 
desiccation  of,  as  means  of  food  concen- 
tration, 70. 
in  diet  of  tropical  climates,  390. 
drying  of,  as  means  of  food  concentra- 
tion, 70. 
necessity  of,  in  diet,  527. 
preparation  of.    See  Recipes,  vegetables, 
preservation  of,  by  dehydration,  9. 

by  drying,  2. 
waste  of,  in  America,  10. 
Vegetarianism.     -See  Vegetable  Diet. 
Vinegar,  use  of,  in  preservation  of  food,  7. 
Vitamine  content  of  foods,  226. 
physiological  estimation  of,  23Z. 
relative,  table  of,  226. 
Vitamines,  antineuritis,  223,  231. 
beri-beri  due  to  lack  of,  230. 
in  cow's  milk,  498. 
destructive  action  of  heat  on,  222. . 
isolation  of,  221. 
in  metabolism,  224,  229. 
nature  of,  221. 
and  pellagra,  232,  237. 
pharmacological  properties  of,  222. 
physiological  properties  of,  222. 
relation    of,    to   phosphorus   content   of 

foods,   233. 
scurvy  in  infants  due  to  destruction  of, 

"  498. 
tables  showing  effect  of  whole  gram  and 
of  highly  milled  cereals  on  fowls, 
235. 
in  well-balanced  dietary,  224. 
Voit's  standard  dietary  for  aged  persons, 
442. 


w 


Wait's  vegetarian  and  fat  dietary,  528. 
War,  food  economics  in.     See  Food  Econo- 
mics in  War. 
food  situation  in  countries  at.   See  Food 
Situations. 
Waste  of  foodstuffs,  economically,  103. 
fats,  105. 

physiologically,  104. 
nutrient,     percentage    of,     in    ordinary 
mixed  diet,  106. 
Water,  drinking  of,  with  meals,  88. 
importance  of,  to  infants,  497. 
metabolism  of,  308. 
Weaning,  duration  of,  483. 
false  indications  for,  485. 
Weight  of  body,  food  requirement  propor- 
tionate to.  266. 
Weight  and  height,  comparative,  of  chil- 
dren, table  of,  412. 
relation  of,  363. 

at  varying  ages,  standard,  table  of.  364. 
Weir  Mitchell   diet   in   treatment  of  neu- 
rasthenia  and   disorders   of  mal- 
nutrition independent  of  organic 
disease,  549. 
Wheat,  production  of,  in  United  States, 
769. 
use  of,  in  war,  759. 
Whey  cure,  573. 

Woric,  effects  of  food  and,  on  respiration, 
293. 
and  food,  79. 

influence  of,  on  food  required.  184. 
Playfair's  table  of  requirements  for,  377. 


Xanthin,  formation  of,  332. 


Yeast,  dehydration  of,  45. 
Yolk  cure,  563. 


Zymotherapy,  538. 


Date  Due 

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PRINTED  IN  U.S.*.                 CAT.     NO.    24     161                   ^ 

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5i 


A  000  510  213  2 


WBUoO 
F5U6d 
1918 
V.  2 
Fitch,  William  Edvard. 

Dietotherapy ,  nutrition  and 

diet  in  health. 


I 


WBUoo 
F5k6d 
1918 
V.  2 
Fitch,  William  Edward. 

Dietotherapy,  nutrition  and  diet  in 

health . 


I 


> 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 
IRVINE,  CALIFORNIA  92664 


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